Compositions and methods for targeting cancer-specific sequence variations

Abstract

The present invention relates to compositions and methods for targeting <span class="c7 g0">cancerspan>-specific DNA sequences, such as copy <span class="c10 g0">numberspan> amplifications and other types of <span class="c7 g0">cancerspan>-specific <span class="c3 g0">sequencespan> variations, such as <span class="c7 g0">cancerspan>-specific polymorphisms, insertions, or deletions. The present invention provides hereto <span class="c3 g0">sequencespan>-specific DNA targeting agents targeting a <span class="c3 g0">sequencespan> within the amplified DNA region or a <span class="c3 g0">sequencespan> otherwise specific for a <span class="c7 g0">cancerspan> <span class="c6 g0">cellspan> compared to a non-<span class="c7 g0">cancerspan> <span class="c6 g0">cellspan>. The invention further relates to methods for treating <span class="c7 g0">cancerspan>, comprising administering such <span class="c3 g0">sequencespan>-specific DNA targeting agents. The invention further relates to methods for preparing <span class="c3 g0">sequencespan>-specific DNA targeting <span class="c16 g0">agentspan>, as well as screening methods using the DNA targeting agents.

Description

RELATED APPLICATIONS AND INCORPORATION BY REFERENCE

This application claims priority and benefit of U.S. provisional application Ser. No. 62/246,988, filed Oct. 27, 2015.

The foregoing applications, and all documents cited therein or during their prosecution (“appln cited documents”) and all documents cited or referenced in the appin cited documents, and all documents cited or referenced herein (“herein cited documents”), and all documents cited or referenced in herein cited documents, together with any manufacturer's instructions, descriptions, product specifications, and product sheets for any products mentioned herein or in any document incorporated by reference herein, are hereby incorporated herein by reference, and may be employed in the practice of the invention. More specifically, all referenced documents are incorporated by reference to the same extent as if each individual document was specifically and individually indicated to be incorporated by reference.

SEQUENCE LISTING

The instant application contains a “lengthy” Sequence Listing which has been submitted via CD-R in lieu of a printed paper copy, and is hereby incorporated by reference in its entirety. Said CD-R, recorded on Dec. 13, 2016, is labeled “CRF” and contains one 328,759 bytes file (46783_99_2147_SL.txt).

FEDERAL FUNDING LEGEND

This invention was made with government support under Grant No. CA176058 awarded by National Institutes of Health. The government has certain rights in the invention.

FIELD OF THE INVENTION

The present invention relates to methods and compositions for identifying therapeutics as well as screening for therapeutic efficiency as well as the development of therapeutics, in particular for the treatment of disorders characterized by specific DNA variations, such as cancer specific DNA variations, including amplifications, indels, (single nucleotide) polymorphisms, etc. The present invention also relates to compositions and methods for treating disorders characterized by DNA such specific DNA variations.

BACKGROUND OF THE INVENTION

Chemotherapy and radiation have long been the foundation of therapy for advanced cancers (1, 2). Many chemotherapy agents (e.g. cisplatin), as well as ionizing radiation, work by inducing DNA-damage that is not adequately repaired by cancer cells. While many cancer cells are more susceptible than normal cells to chemotherapy and radiation, a major limitation of these treatment approaches is the non-specific nature of these modalities and the narrow therapeutic window for preferential killing of cancer cells versus of normal cells. Furthermore, few validated biomarkers for response to DNA damaging agents have been identified, thereby leading to non-specific utilization of these approaches in many patients who unfortunately will not respond to such therapy yet still suffer the side-effects of such cytotoxic treatments.

Thus there is a need for more rational and effective strategies for cancer treatments, such as more targeted and patient-specific utilization of DNA-damaging agents or chemotherapeutics.

Citation or identification of any document in this application is not an admission that such document is available as prior art to the present invention.

SUMMARY OF THE INVENTION

The present invention relates to a more rational and effective strategy for utilization of DNA-damaging agents by specifically targeting regions of DNA that vary in sequence or abundance between cancer and normal cells, thus expanding the therapeutic window and allowing high dose therapy in a cancer-specific manner. Such a biomarker-driven approach to targeted utilization of DNA-damaging agents has not been developed to date.

The invention is based on the unexpected observation that in different types of cancer cells there is a striking correlation between sequence-targeted genomic modifications within regions of copy number amplification and the consequent impairment in cancer cell proliferation and viability, as established by gene targeting for instance by CRISPR/Cas. It has moreover been established that the magnitude of dependency increases with the amplitude of copy number amplification, with high-level copy number amplifications being responsible for the most profound dependencies being observed within a particular cancer cell line. Interestingly, it appears that this effect is independent of gene expression and thus related to the DNA modification itself as well as the cellular response to this modification. It has been derived therefrom that cancer cells can be selectively targeted by targeting for instance non-essential genes or even non-coding, intergenic regions of cancer-specific sequences, including amplified DNA, (single nucleotide) polymorphisms, indels, etc., with a DNA targeting agent. Indeed, targeting non-coding regions of amplification would dramatically expand the number of targetable loci while also opening the possibility of novel therapies with an improved therapeutic window and efficacy.

Without wishing to be bound by theory, mechanistically, targeting amplified DNA regions, and by extension cancer specific sequences in general, may lead to an intolerable level of DNA damage burden in cancer cells (with likely impaired DNA damage repair), thus resulting in mitotic catastrophe with resultant cell cycle arrest or cell death. In such case, it is postulated that diploid normal cells with intact DNA damage repair would sustain lower DNA damage burden from such sequence-directed DNA damage and thus not show significant sensitivity.

Alternatively, an essential driver oncogene may be structurally amplified through tandem repeats within the same chromosome. Induced DNA damage may then be repaired by non-homologous end joining (NHEJ) by cancer and normal cells. In cancer cells however, the net result is recombination of proximal and distal chromosome fragments, leading to loss of copies of the essential driver gene, thereby leading to cell cycle arrest or cell death. In normal cells, NHEJ repairs DNA in an error prone manner that is well tolerated by these cells, especially when a non-essential gene is targeted.

Importantly, both of the above models suggest that targeting non-essential genes or even non-coding, intergenic regions of for instance cancer-specific target sequences, such as amplified DNA, polymorphisms, indels, etc., with DNA damaging agents, such as without limitation, CRISPR-Cas9 technology reveals profound vulnerabilities specific in cancer cells.

CRISPR-Cas9 technology allows genome editing through induction of double stranded breaks in DNA by the CAS9 nuclease in a sequence-specific manner through single guide RNAs (sgRNAs). The CRISPR-Cas9 system requires introduction of two fundamental components into cells: 1) the RNA-guided CRISPR-associated Cas9 nuclease and 2) a single guide RNA (sgRNA) that directs the Cas9 nuclease to specific regions of the genome based on complementarity to the guide RNA (3-8). For CRISPR-Cas9-mediated knock-out, Cas9 introduces a double strand break in DNA within the region of complementarity to the sgRNA, and this break is subsequently repaired in an error-prone manner through non-homologous end joining (NHEJ) by introduction of an insertion/deletion (indel) mutation and subsequent coding frameshift (8)

While the data presented herein are derived from CRISPR-Cas9 screening, the invention is more broadly applicable and that other sequence-specific DNA-damaging agents may yield similar cancer-specific, such as amplification-dependency profiles. The underlying concept that cancer cells with genomic amplification (or acquired tumor-specific sequence variation such as single nucleotide variants or insertions/deletions) are profoundly sensitive to introduction of site-specific double-strand breaks forms the foundation for an entirely new class of therapeutic agents that can be termed “site-specific DNA damaging agents.” Additional examples of such agents might include additional genome editing technologies such as Transcription activator-like effector nucleases (TALENs), Zinc-finger nucleases (ZFNs) or other nuclease proteins capable of site-directed DNA cleavage, all of which are equally applicable as sequence specific DNA damaging agents as described herein. Moreover, small molecule approaches that achieve preferential targeting in a site-specific manner within regions of amplified DNA are equally applicable as sequence specific DNA damaging agents as described herein. For instance, oligonucleotide-directed chemotherapeutic molecules or radioactive isotopes can be delivered in a sequence specific manner for targeting of amplified regions of for instance cancer genomes. Moreover, utilization of the site-specific recognition of CRISPR-Cas9 to deliver nuclease-dead versions of Cas9 conjugated with DNA-damaging agents directly to cancer-specific regions, including amplified regions, (single nucleotide) polymorphisms, indels, etc., is an additional approach which is also applicable according to the invention. These novel agents may be used in combination with other treatment modalities such as cytotoxic DNA-damaging chemotherapies (e.g. cisplatin, etoposide), ionizing radiation, DNA-damage repair inhibitors (e.g. PARP-inhibitors) and apoptotic modulators (e.g. ABT-263) to enhance their cancer-specific impact. It is anticipated that the site-specific nature (in case of DNA amplification by virtue of the presence of multiple target copies, or in case of cancer-specific sequences by virtue of the absence of such sequences in non-cancerous tissues or cells) of the proposed novel class of therapies would enable dose reduction of conventional agents, such as cytotoxic chemotherapy or radiation therapy, and thus mitigation of possible side effects to the patient. Alternatively, by virtue of its specificity for tumor cells, a higher dose may lead to less side effects or off-target effects.

In addition to the above, when providing one or more sequence specific, such as an amplicon specific DNA targeting agent or a polymorphism-specific DNA targeting agent, with for instance a cytotoxic agent coupled thereto, such as a chemotherapeutic, similarly to inducing DNA damage, the cell may be faced with an intolerable level of cytotoxicity, thus resulting in cellular damage and death. This cytotoxicity may be conferred by therapeutic agents that are localized preferentially to cancer cell nuclei by virtue of sequence-specific DNA-targeting, with the cytotoxicity mediated by DNA-damage or an alternative cell-damaging mechanism, such as interruption of the nuclear architecture or interference with chromatin structural components or remodeling enzymes.

By exploiting copy number variations, in particular DNA amplifications as cancer specific traits, therapeutic efficacy may be “amplified” specifically in cancer cells, i.e. by specifically targeting amplified DNA regions. Alternatively, or in addition, cancer-specific DNA variations likewise “amplify” targeting vis-à-vis normal cells. Advantageously, a multiplexed system (i.e. targeting simultaneously multiple cancer-specific targets) will further amplify therapeutic efficacy. Simultaneous combination of cancer-specific DNA targeting agents to target multiple loci within a given cancer cell maximizes the tumor-specific impact of this approach. This approach utilizes combination reagents to effect site-specific DNA damage in specific regions of the cancer genome that have specificity over the genome of normal cells. While targeted therapies, such as kinase inhibitors, may be susceptible to cancer cells evolution of resistance through a variety of mechanisms (increased expression, point mutations) that circumvent the targeted mechanism of action, sequence-specific DNA targeting (e.g. DNA damaging) agents are expected to be less susceptible to such mechanisms of resistance.

In an aspect, the invention relates to a method for developing or designing a DNA targeting agent for treating a cancer, such as a copy number driven cancer or a cancer having a cancer-specific sequence variation. The method comprises identifying a cancer-specific sequence variation and designing a DNA targeting agent which targets the cancer-specific sequence variation in a sequence specific manner. In certain embodiments, the cancer-specific sequence variation may be identified through appropriate comparison of control biological material with disease-derived material, preferably originating from the same subject. In certain embodiments, such material may be obtained through biopsy, such as for instance in particular in case of solid material. Alternatively, fluid samples may be obtained as well. In certain embodiments, the control samples and/or the disease samples may or may not be patient-specific, and may or may not be derived from the same individual.

In a related aspect, the invention provides for a method of identifying a cancer-specific biomarker indicative of susceptibility of a subject to treatment with a DNA targeting agent as defined herein, which comprises (i) identifying one or more cancer-specific sequence variation within a population of subjects treated with said DNA targeting agent and (ii) identifying subjects susceptible to said treatment and (iii) thereby identifying cancer-specific sequence variations as biomarkers. The so-identified biomarkers will form an indication of susceptibility of the subject for treatment with the DNA targeting agent, which will target the DNA in a sequence specific manner. In certain embodiments, the subject is afflicted with cancer.

In a further related aspect, the invention provides for a method of determining the susceptibility of a subject to treatment with a DNA targeting agent as defined herein, said method comprising (i) identifying in a sample of a subject the presence of one or more cancer-specific sequence variation and (ii) determining based thereon whether or not said patient is susceptible to said treatment. Such method may include determining the presence of an biomarker as defined herein indicative of a cancer-specific sequence variation in said sample. In certain embodiments, the samples are derived from subjects having a proliferative disease, wherein the samples may be tumor samples.

In a related aspect, the invention provides for a method of identifying a target DNA sequence for the development of an anti-proliferative agent, said method comprising (i) selectively generating DNA damage in the genome of a cell derived from a subject having a proliferative disease, such as a cancer cell, (ii) determining whether or not said DNA damage affects cell proliferation or viability (iii), identifying one or more discrete vulnerability regions within said genome for which said DNA damage affects cell proliferation or viability and (iv) identifying a DNA sequence within said one or more vulnerability regions as said target sequence. In certain embodiments, step (iii) comprises mapping said regions for which said DNA damage affects cell proliferation or viability within areas of copy number amplification or within areas harbouring one or more cancer-specific sequence variation. In certain embodiments, such target sequence is a non-coding sequence, such as for instance an intergenic sequence.

The DNA targeting agent according to the invention as defined herein may comprise a sequence specific probe, such as an amplicon specific probe, more in particular, an amplicon specific probe specific for a proliferative disease, such as cancer, or a cancer-specific sequence variation specific probe, such as a (single nucleotide) polymorphism probe or a probe specific for cancer-specific genomic insertions, deletions, or indels; and further comprises a DNA damaging agent or a cytotoxic agent, such as a nuclease, radio-active isotope, DNA cross-linker, topoisomerase inhibitor, or DNA intercalation agent, etc. the DNA targeting agent as described herein may comprise a nucleic acid agent, which may for instance be DNA or RNA.

In an aspect, the invention relates to a sequence-specific DNA targeting agent, or a pharmaceutical composition comprising such, wherein the sequence-specific DNA targeting agent targets a cancer-specific sequence variation, such as a sequence within a DNA copy number variation (CNV), preferably resulting from an amplification, preferably specific for a proliferative disease, such as cancer, or a cancer-specific (single nucleotide) polymorphism or a cancer-specific genomic insertion, deletion, or indel.

In a related aspect, the invention provides for the use of a sequence-specific DNA targeting agent, or a pharmaceutical composition comprising such, wherein the sequence-specific DNA targeting agent targets a cancer-specific sequence variation, such as sequence within a DNA copy number variation (CNV), preferably resulting from an amplification, preferably specific for a proliferative disease, such as cancer, or a cancer-specific (single nucleotide) polymorphism or a cancer-specific genomic insertion, deletion, or indel, for the manufacture of a medicament for treating a proliferative disorder, such as cancer, preferably a proliferative disorder such as cancer characterized by DNA copy number variation (CNV), preferably resulting from an amplification, preferably specific for a proliferative disease, such as cancer, or characterized by a cancer-specific (single nucleotide) polymorphism or a cancer-specific genomic insertion, deletion, or indel.

In a related aspect, the invention provides for the use of a sequence-specific DNA targeting agent, or a pharmaceutical composition comprising such, wherein the sequence-specific DNA targeting agent targets a cancer-specific sequence variation, such as sequence within a DNA copy number variation (CNV), preferably resulting from an amplification, preferably specific for a proliferative disease, such as cancer, or a cancer-specific (single nucleotide) polymorphism or a cancer-specific genomic insertion, deletion, or indel, for treating a proliferative disorder, such as cancer, preferably a proliferative disorder such as cancer characterized by DNA copy number variation (CNV), preferably resulting from an amplification, preferably specific for a proliferative disease, such as cancer, or a cancer-specific (single nucleotide) polymorphism or a cancer-specific genomic insertion, deletion, or indel.

In yet a further relates aspect, the invention provides for a sequence-specific DNA targeting agent, or a pharmaceutical composition comprising such, wherein the sequence-specific DNA targeting agent targets a cancer-specific sequence variation, such as sequence within a DNA copy number variation (CNV) resulting from an amplification, preferably specific for a proliferative disease, such as cancer, or a cancer-specific (single nucleotide) polymorphism or a cancer-specific genomic insertion, deletion, or indel, for the manufacture of a medicament for use in treating a proliferative disorder, such as cancer, preferably a proliferative disorder such as cancer characterized by DNA copy number variation (CNV), preferably resulting from an amplification, preferably specific for a proliferative disease, such as cancer, or a cancer-specific (single nucleotide) polymorphism or a cancer-specific genomic insertion, deletion, or indel.

In yet a further aspect, the invention provides for a method of treating a disease having a cancer-specific sequence variation, such as DNA copy number variation (CNV), preferably resulting from an amplification in a subject in need thereof, preferably specific for a proliferative disease, such as cancer, or a cancer-specific (single nucleotide) polymorphism or a cancer-specific genomic insertion, deletion, or indel, comprising administering to a subject in need thereof at least a DNA targeting agent or pharmaceutical composition according to the invention as defined herein.

It is specifically envisioned herein that genomic and functional genetic data derived from patient-specific biopsy material enables identification of cancer-specific biomarkers, such as amplicon biomarkers, (single nucleotide) polymorphisms, indels, etc, that guide development of cancer-specific DNA-targeting agents to target copy number-driven cancer types. Such therapies can be developed to commonly occurring regions of amplification, such as by means of example, and without limitation, 8q24 harboring MYC, and patients can be enrolled onto trials based on the presence of such amplifications within their tumor genome. Importantly, underlying DNA repair defects (e.g. BRCA1/2, PALB2, TP53 or ATM) may also have predictive value for response to such site-specific DNA targeting agents and thus could further facilitate patient stratification. Through this approach, the present invention provides in a precision medicine strategy to the development of patient-specific therapies based on individual cancer genome and functional dependency analyses.

In certain embodiments in the methods and compositions as defined herein according to the invention, the DNA targeting agent comprises a (DNA) nuclease, such as a nuclease which can target DNA in a sequence specific manner or which can be directed or instructed to target DNA in a sequence specific manner, such as a CRISPR Cas system, Zinc finger nuclease (ZFN), Transcription Activator-Like Effector Nuclease (TALEN), or meganuclease; as defined herein elsewhere.

The invention is in particular captured by the below listed numbered statements 1 to 54:

1. A method for preparing a DNA targeting agent suitable for the treatment of cancer, said method comprising identifying a cancer cell-specific sequence variation in cancer cells of said cancer and producing a sequence-specific DNA targeting agent targeting said sequence.

2. The method of statement 1 which comprises identifying said cancer cell-specific sequence variation by sequencing of a sample of said cancer.

3. The method according to statement 1 or 2, wherein said DNA targeting agent is a patient-specific DNA targeting agent, and said cancer cell-specific sequence variation is identified based on sequencing a sample of said patient.

4. A method of identifying a biomarker indicative of susceptibility of a patient to treatment with a DNA targeting agent said method comprising (i) identifying cancer cell-specific sequence variations within a population of patients treated with said DNA targeting agent and (ii) identifying patients susceptible to said treatment and (iii) thereby identifying cancer cell-specific sequence variations as biomarkers.

5. A method for determining the susceptibility of a patient to treatment with a DNA targeting agent said method comprising (i) identifying in a sample of a patient the presence of one or more cancer cell-specific sequence variation and (ii) determining based thereon whether or not said patient is susceptible to said treatment.

6. The method according to statement 5, which comprises determining the presence of a biomarker indicative of a cancer cell-specific sequence variation in said sample.

7. The method according to statement 5 or 6, wherein the sample is a tumor sample.

The method according to any of statements 1 to 7, wherein said cancer cell-specific sequence variation is a cancer-specific nucleotide alteration.

The method according to any of statements 1 to 8, wherein said cancer cell-specific sequence variation comprises a cancer-specific DNA copy number variation (CNV), a cancer-specific (single nucleotide) polymorphism, a cancer-specific DNA insertion, or a cancer-specific DNA deletion.

10. A method for identifying a target DNA sequence for the development of an anti-proliferative agent, said method comprising (i) selectively generating DNA damage in the genome of a cancer cell, (ii) determining whether or not said DNA damage affects cell proliferation or viability (iii), identifying one or more discrete vulnerability regions within said genome for which said DNA damage affects cell proliferation or viability and (iv) identifying a DNA sequence within said one or more vulnerability regions as said target sequence.

11. The method of statement 8, wherein step (iii) comprises mapping said regions for which said DNA damage affects cell proliferation or viability within areas of copy number amplification.

12. The method according to any of statements 1 to 10, wherein said cancer cell-specific sequence variation is within a non-coding region or a sequence in a non-essential gene within said vulnerability region.

13. The method according of any one of statements 1 to 12, wherein said DNA targeting agent is or comprises a DNA damaging agent, a cytotoxic agent, or an anti-proliferative agent.

14. The method according to any of statements 1 to 13, wherein said DNA targeting agent comprises a nuclease, radio-active isotope, DNA cross-linker, topoisomerase inhibitor, or DNA intercalation agent.

15. The method of statement 14, wherein the nuclease comprises a Zinc finger nuclease (ZFN), Transcription Activator-Like Effector Nuclease (TALEN), CRISPR/Cas system, or meganuclease.

16. The method of statement 14, wherein said DNA targeting agent is a CRISPR/Cas system comprising a first regulatory element operably linked to a nucleotide sequence encoding a CRISPR-Cas system polynucleotide sequence comprising at least one guide sequence, a tracr RNA, and a tracr mate sequence, wherein the at least one guide sequence hybridizes with the sequence within a CNV; and a second regulatory element operably linked to a nucleotide sequence encoding a Type II Cas9 protein; and wherein components (i) and (ii) are located on same or different vectors of the system, whereby the guide sequence targets the sequence within a CNV.

17. A sequence-specific DNA targeting agent, wherein the sequence-specific DNA targeting agent targets a cancer cell-specific sequence variation, or a pharmaceutical composition comprising a. sequence-specific DNA targeting agent, wherein the sequence-specific DNA targeting agent targets a cancer cell-specific sequence variation.

18. The targeting agent or pharmaceutical composition according to statement 17, wherein the sequence-specific DNA targeting agent targets a sequence within a DNA copy number variation (CNV) resulting from an amplification, or a cancer cell specific DNA modification.

19. The sequence-specific DNA targeting agent or pharmaceutical composition according to statement 17 or 18, wherein said cancer cell-specific sequence variation comprises a cancer-specific (single nucleotide) polymorphism, a cancer-specific DNA insertion, or a cancer-specific deletion.

20. The sequence-specific DNA targeting agent or pharmaceutical composition according to any of statements 17 to 19, wherein said cancer cell-specific sequence variation is not present in a normal cell or a non-cancerous cell.

21. The sequence-specific DNA targeting agent or pharmaceutical composition according to any of statements 17 to 20, wherein said cancer cell-specific sequence variation is amplified in said cancer cell compared to a normal cell or non-cancerous cell.

22. The targeting agent or pharmaceutical composition according to statement 18, wherein the CNV comprises DNA copy number amplifications of 1p22-p31, 1p32-p36, 1q, 2p13-p16, 2p23-p25, 2q31-q33, 3q, 5p, 6p12-pter, 7p12-p13, 7q11.2, 7q21-q22, 8p11-p12, 8q, 11q13-q14, 12p, 12q13-q21, 13q14, 13q22-qter, 14q13-q21, 15q24-qter, 17p11.2-p12, 17g12-q21, 17q22-qter, 18q, 19p13.2-pter, 19cen-q13.3, 20p11.2-p12, 20q, Xp11.2-p21, or Xp11-q13.

23. The targeting agent or pharmaceutical composition according to any of statements 17 to 22, wherein off target frequency of the sequence-specific DNA targeting agent is less than 5 non-target sites.

24. The targeting agent or pharmaceutical composition according to any of statements 17 to 23, wherein the sequence-specific DNA targeting agent targets a non-coding sequence or a sequence in a non-essential gene.

25. The targeting agent or pharmaceutical composition according of any one of statements 17 to 24, wherein said DNA targeting agent is or comprises a DNA damaging agent, a cytotoxic agent, or an anti-proliferative agent.

26. The targeting agent or pharmaceutical composition according to any of statements 17 to 25, wherein the sequence-specific DNA targeting agent comprises a nuclease, radio-active isotope, DNA cross-linker, topoisomerase inhibitor, DNA intercalation agent, or a cytotoxic molecule.

27. The targeting agent or pharmaceutical composition according to statement 26, wherein the nuclease comprises a Zinc finger nuclease (ZFN), Transcription Activator-Like Effector Nuclease (TALEN), CRISPR/Cas system, or meganuclease.

28. The targeting agent or pharmaceutical composition according to statement 27, wherein the sequence-specific DNA targeting agent comprises a nucleic acid agent.

29. The targeting agent or pharmaceutical composition according to statement 28, wherein the nucleic acid may be administered by a vector system comprising at least one vector.

30. The targeting agent or pharmaceutical composition according to statement 29, wherein the vector system comprises a lentivirus, adenovirus, adeno associated virus (AAV), herpesvirus, or poxvirus.

31. The targeting agent or pharmaceutical composition according to any of statements 27 to 30, wherein the (CRISPR-Cas) system comprises: a first regulatory element operably linked to a nucleotide sequence encoding a CRISPR-Cas system polynucleotide sequence comprising at least one guide sequence, a tracr RNA, and a tracr mate sequence, wherein the at least one guide sequence hybridizes with the sequence within a CNV; and a second regulatory element operably linked to a nucleotide sequence encoding a Type II Cas9 protein; and wherein components (i) and (ii) are located on same or different vectors of the system, whereby the guide sequence targets the sequence within a CNV.

32. The system of statement 31, wherein the CRISPR-Cas system is codon optimized.

33. The system according to statements 31 or 32, wherein the Cas9 protein is a nickase.

34. The system according to any of statements 31 to 33, wherein the Cas9 protein comprises one or more mutations.

35. The system according to statement 33 or 34, wherein the Cas9 protein comprises one or more mutations selected from D10A, E762A, H840A, N854A, N863A or D986A with reference to the position numbering of a Streptococcus pyogenes Cas9 (SpCas9) protein.

36. The system according to statement 34, wherein the one or more mutations is in a RuvC1 domain of the Cas9 protein.

37. The system according to statement 31, wherein the Cas9 protein cleaves the target sequence.

38. The system according to statement 31, wherein the Cas9 is a dead Cas9 conjugated to a DNA damaging agent or a cytotoxic agent.

39. The system according to any of statements 31 to 38, wherein the CRISPR-Cas system comprises one or more nuclear localization signals expressed with the nucleotide sequence encoding the Cas9 protein.

40. The system according to any of statements 31 to 39, wherein the CRISPR-Cas system polynucleotide sequence comprises a guide sequence fused to a trans-activating cr (tracr) sequence.

41. The system according to any of statements 31 to 40, wherein the CRISPR-Cas system polynucleotide sequence is a chimeric RNA comprising the guide sequence, the tracr sequence, and a tracr mate sequence.

42. A method of treating a disease having a cancer-specific DNA sequence variation a patient in need thereof comprising administering at least one of the pharmaceutical compositions according to any of statements 17 to 41 to the patient.

43. The method according to statement 42, comprising two or more of said pharmaceutical compositions, wherein each of said pharmaceutical compositions targets a different cancer-specific DNA sequence variation.

44. The method according to statements 42 or 43, further comprising detecting one or more cancer-specific DNA sequence variations in the patient or a biological sample obtained from the patient.

45. The method according to statement 44, wherein the pharmaceutical composition targets a cancer-specific DNA sequence variation detected in the patient or a biological sample obtained from the patient.

46. The method according to any of statements 42 to 45, further comprising detecting mutations in DNA damage repair genes in the patient.

47. The method according to any of statements 42 to 46, further comprising administration of one or more additional agents.

48. The method according to statement 47, wherein the additional agents are selected from the group consisting of: chemotherapeutic agents, anti-angiogenesis agents and agents that reduce immune-suppression.

49. The method according to any of statements 42 to 48, wherein the disease is cancer.

50. The method according to statement 49, wherein the cancer comprises solid tumors or blood cancers, including for example: Non-Hodgkin's Lymphoma (NHL), clear cell Renal Cell Carcinoma (ccRCC), melanoma, sarcoma, leukemia or a cancer of the bladder, colon, rectum, brain, breast, head and neck, endometrium, lung, uterus, ovary, peritoneum, fallopian tubes, pancreas, esophagus, stomach, small intestine, liver, gall bladder, bile ducts or prostate.

51. A method of inhibiting growth in a population of cancer cells having a cancer-specific DNA sequence variation comprising administering at least one of the pharmaceutical compositions according to any of statements 17 to 41 to the population of cells.

52. The method according to statement 51, wherein the population of cancer cells are present within a population of cells comprised in an animal or human or a population of cells isolated in tissue culture.

53. The method according to any of statements 42 to 52, wherein said cancer-specific DNA sequence variation comprises a sequence within a DNA copy number variation (CNV) resulting from an amplification, or a cancer cell specific DNA modification.

The method according to any of statements 42 to 53, wherein said cancer cell-specific sequence variation comprises a cancer-specific (single nucleotide) polymorphism, a cancer-specific DNA insertion, or a cancer-specific deletion.

It is an object of the invention to not encompass within the invention any previously known product, process of making the product, or method of using the product such that Applicants reserve the right and hereby disclose a disclaimer of any previously known product, process, or method. It is further noted that the invention does not intend to encompass within the scope of the invention any product, process, or making of the product or method of using the product, which does not meet the written description and enablement requirements of the USPTO (35 U.S.C. § 112, first paragraph) or the EPO (Article 83 of the EPC), such that Applicants reserve the right and hereby disclose a disclaimer of any previously described product, process of making the product, or method of using the product.

It is noted that in this disclosure and particularly in the claims and/or paragraphs, terms such as “comprises”, “comprised”, “comprising” and the like can have the meaning attributed to it in U.S. Patent law; e.g., they can mean “includes”, “included”, “including”, and the like; and that terms such as “consisting essentially of” and “consists essentially of” have the meaning ascribed to them in U.S. Patent law, e.g., they allow for elements not explicitly recited, but exclude elements that are found in the prior art or that affect a basic or novel characteristic of the invention. Nothing herein is intended as a promise.

These and other embodiments are disclosed or are obvious from and encompassed by, the following Detailed Description.

BRIEF DESCRIPTION OF THE DRAWINGS

The patent or application file contains at least one drawing executed in color. Copies of this patent or patent application publication with color drawing(s) will be provided by the Office upon request and payment of the necessary fee.

The following detailed description, given by way of example, but not intended to limit the invention solely to the specific embodiments described, may best be understood in conjunction with the accompanying drawings.

FIG. 1A-1G. Genome-scale CRISPR-Cas9 screening in cancer cell lines. (A) Schematic of the pooled screening process. (B) Time point analysis. Cumulative frequency of sgRNAs to ribosome, proteasome and spliceosome subunits in both the initial DNA reference pool (blue dotted) and 7 (cyan), 14 (purple), 21 (blue) and 28 (green) days after transduction in COLO699. Also overlaid is the cumulative frequency of sgRNAs to non-targeting controls for COLO699 at all timepoints (red) and the initial reference DNA pool (black dotted). (C) A boxplot of correlation between replicates (y-axis) plotted for each cell line, including early timepoints, (x-axis) shows the range of replicate-replicate correlations after quality control was applied. (D) The first principal component (x-axis) was plotted against the second principal component (y-axis) using the sgRNA data for all cell lines. Each point is a replicate sample of an individual cell line after quality control was applied. (E) Cas9 activity on the indicated days post-infection (x-axis) across 20 cell lines with at least 4 timepoints. Lines are separated into 3 panels depending on Cas9 activity over time and the colored dot at day 12-13 indicate measurement used for overall Cas9 activity. (F) Percent Cas9 activity (x-axis) is plotted against the depletion efficiency (median of positive-median of negative controls) (y-axis) for each replicate sample of all cell lines passing quality control. (G) Principal component analysis showing a correlation of the first principal component in the sgRNA level data to Cas9 activity. The first principal component (x-axis) was plotted against the second principal component (y-axis) using the sgRNA data for all cell lines. Percent Cas9 activity per cell line is binned and colored.

FIG. 2A-2D. Identification of oncogene dependencies in CRISPR-Cas9 screening data. (A) KRAS dependency in KRAS mutant cell lines (red). (B) ABL1 kinase dependency in BCR-ABL translocated leukemia (red). (C) Estrogen receptor dependency in estrogen-receptor positive breast cancer. (D) Androgen receptor dependency in androgen receptor positive prostate cancer.

FIG. 3A-3G. Genome-scale CRISPR-Cas9 screening identifies a strong correlation between copy number and gene dependency. (A-C) Genomic copy number and CRISPR-Cas9 gene dependency scores plotted according to genomic coordinates (x-axis). Data are shown for three amplified and dependent loci: (A) Chromosome 19q in Panc-1; (B) Chromosome 19q in SU86.86; (C) Chromosome 8q in HT29. Top track in each plot corresponds to SNP copy number data with amplified regions highlighted in red. Bottom track shows CRISPR-dependency data highlighted in purple with each point representing the composite ATARiS gene score for a single gene plotted by chromosome position. shRNA screening data are simultaneously plotted in orange (B,C). (D) Whole-genome views of three cell lines (A375, CAL120 and HT29) displaying three tracks each: Top—heat map of segmented copy number data; Middle—heat map of segmented CRISPR-dependency data; Bottom—column plot of sgRNA-level CRISPR-dependency data, with each bar representing a single sgRNA. (E) Plot of CRISPR dependency vs. gene expression by RNA-sequencing for all genes on the indicated locus in SU86.86 cell line. (F) Boxplots of CRISPR-Cas9 dependency score for non-genic off-target perfect match sgRNAS within amplicons in the K562 cell line and the corresponding “sister” sgRNAs for the non-genic sgRNAs targeting the same genes as the putative target for the non-genic sgRNAs. p-value=8.632e-14 for T-test. (G) Boxplots of non-genic perfect match off-target sgRNAs within amplicons and their corresponding “sister” sgRNAs targeting the supposed Target gene. p-value=0.03343 for T-test between classes.

FIG. 4A-4E. Global summary of CRISPR-CN observation. (A) Mean CRISPR dependency (Y-axis) for each copy-number defined segment (X-axis) is plotted for all copy-number segments across the dataset of lines screened with CRISPR-Cas9 (Table 1). (B) Mean CRISPR dependency (Y-axis) and most dependent shRNA value is plotted for each copy-number defined segment across all cell lines with both CRISPR-Cas9 and shRNA screening data. (C) Mean CRISPR-Cas9 dependency (Y-axis) vs. Copy number (X-axis) plots for individual cell lines. Each open circle represents a single segment of defined copy number from the segmented copy number data for the indicated cell line. The size of the circle corresponds to the number of genes on the segment. Non-targeting negative control sgRNAs are shown as a box plot embedded within the scatter plot. Data are shown for representative cell lines showing strong correlation of CRISPR-Cas9 dependency with copy number (C). (D) Plot of the CN effect on dependency (Y-axis) versus the positive-negative log ratio (x-axis; a surrogate for Cas9 activity). The CN effect on dependency is summarized on a per cell line basis as the slope of the mean CRISPR-Cas9 dependency versus copy number plots for each cell line, as defined in panel (A). (E) Bar graph depicting the fraction of gene dependencies residing in loci of high-level amplification (Log2CNV>1) at the indicated CRISPR and shRNA dependency values (Z-scores).

FIG. 5. Schematic summary of the copy number and CRISPR-Cas9 dependency relationship in CRISPR-Cas9 screening data. A schematic is shown for a hypothetical complex copy number alteration within a cancer cell line. Segmented copy number is plotted as a continuous black line, with hypothetical integer copy number values indicated above each copy number plateau. CRISPR-Cas9 dependency scores mapped according to chromosome position are shown throughout the locus. Red bars indicate those CRISPR-Cas9 probes that are enriched (above baseline) in the pooled screening data and blue bars indicate those probes that are depleted (below baseline) in the pooled screens. The length of the bar corresponds to the relative magnitude of enrichment or depletion.

FIG. 6A-6B. DNA damage hypothesis for etiology of CRISPR-Amplification dependency. Sequence-specific DNA damage induced by CRISPR-Cas9 (or possibly other agents) leads to increased burden of DNA damage in cancer cells (A) with amplified regions of the genome and likely impaired DNA damage repair as compared to diploid normal cells with intact DNA damage repair (B). Genes are indicated by letters (A, B, C . . . ). Red bar indicates dsDNA-break, such as that induced by CRISPR-Cas9. Putative driver gene on amplification is highlighted in yellow, although this model does not necessarily require there to be a driver oncogene within the amplified region. Blue star indicates sites of unrepaired dsDNA break. Pink X indicates gene knock-out through error-prone repair of dsDNA breaks. NHEJ, non-homologous end joining. Sequence-specific targeting of gene D is shown here for ease of description; however, targeting of non-coding, intergenic regions may also show a similar phenomenon.

FIG. 7A-7B. Driver gene hypothesis for etiology of CRISPR-Amplification dependency. Sequence-specific DNA damage is induced by CRISPR-Cas9 or other agents (red bar) in areas of tandem repeat DNA amplification harboring a driver oncogene (yellow highlighting). Cancer cells (A) undergo multiple dsDNA breaks on the same chromosome whereas normal cells (B) undergo only a single sequence-specific break on each chromosome. NHEJ repairs dsDNA breaks in an error-prone manner, leading to recombination of proximal and distal chromosome fragments. In cancer cells, Applicants propose that this could lead to loss of copies of the essential driver gene, thereby leading to cell cycle arrest or cell death. Legend is the same as in FIG. 6.

FIG. 8. Sequence-specific DNA damaging agents as a therapeutic modality in copy-number driven cancers. Sequence-specific DNA damaging agents may target amplified regions of DNA with a wide therapeutic window for cancer vs. normal cells. CRISPR-Cas9 and Oligo-directed chemo- or radiotherapy are shown as two possible examples; however, other sequence-specific approaches may also be applicable (other nucleases, small molecules, radioisotopes, etc.).

FIG. 9. Personalized cancer therapy with sequence-specific DNA damaging agents. A patient's tumor is biopsied and whole exome or genome sequencing is performed to identify structural aberrations and copy number amplifications as cancer-specific biomarkers. In parallel cell-based models are derived from the sample, and ultimately utilized for focused CRISPR-Cas9 dependency profiling for coding and non-coding regions of the amplified genome. Sequence-specific DNA damaging agents with adequate tumor delivery are developed, undergo in vitro testing and ultimately progress to phase I clinical trials.

The figures herein are for illustrative purposes only and are not necessarily drawn to scale.

DETAILED DESCRIPTION OF THE INVENTION

Before the present methods of the invention are described, it is to be understood that this invention is not limited to particular methods, components, products or combinations described, as such methods, components, products and combinations may, of course, vary. It is also to be understood that the terminology used herein is not intended to be limiting, since the scope of the present invention will be limited only by the appended claims.

Preferred statements (features) and embodiments of this invention are set herein below. Each statements and embodiments of the invention so defined may be combined with any other statement and/or embodiments unless clearly indicated to the contrary. In particular, any feature indicated as being preferred or advantageous may be combined with any other feature or features or statements indicated as being preferred or advantageous. Hereto, the present invention is in particular captured by any one or any combination of one or more of the below numbered aspects and embodiments 1 to 74, with any other statement and/or embodiments. The present invention will be described with respect to particular embodiments but the invention is not limited thereto but only by the claims. Any reference signs in the claims shall not be construed as limiting the scope.

Where the term “comprising” is used in the present description and claims, it does not exclude other elements or steps. The terms “comprising”, “comprises” and “comprised of” as used herein are synonymous with “including”, “includes” or “containing”, “contains”, and are inclusive or open-ended and do not exclude additional, non-recited members, elements or method steps. It will be appreciated that the terms “comprising”, “comprises” and “comprised of” as used herein comprise the terms “consisting of”, “consists” and “consists of”, as well as the terms “consisting essentially of”, “consists essentially” and “consists essentially of”. “Consisting essentially of” permits inclusion of additional components not listed, provided that they do not materially affect the basic and novel properties of the invention.

As used herein, the singular forms “a”, “an”, and “the” include both singular and plural referents unless the context clearly dictates otherwise.

The recitation of numerical ranges by endpoints includes all numbers and fractions subsumed within the respective ranges, as well as the recited endpoints.

The term “about” or “approximately” as used herein when referring to a measurable value such as a parameter, an amount, a temporal duration, and the like, is meant to encompass variations of +/−20% or less, preferably +/−10% or less, more preferably +/−5% or less, and still more preferably +/−1% or less of and from the specified value, insofar such variations are appropriate to perform in the disclosed invention. It is to be understood that the value to which the modifier “about” or “approximately” refers is itself also specifically, and preferably, disclosed.

Whereas the terms “one or more” or “at least one”, such as one or more or at least one member(s) of a group of members, is clear per se, by means of further exemplification, the term encompasses inter alia a reference to any one of said members, or to any two or more of said members, such as, e.g., any ≥3, ≥4, ≥5, ≥6 or ≥7 etc. of said members, and up to all said members.

All references cited in the present specification are hereby incorporated by reference in their entirety. In particular, the teachings of all references herein specifically referred to are incorporated by reference.

Unless otherwise defined, all terms used in disclosing the invention, including technical and scientific terms, have the meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. By means of further guidance, term definitions are included to better appreciate the teaching of the present invention.

Reference throughout this specification to “one embodiment” or “an embodiment” means that a particular feature, structure or characteristic described in connection with the embodiment is included in at least one embodiment of the present invention. Thus, appearances of the phrases “in one embodiment” or “in an embodiment” in various places throughout this specification are not necessarily all referring to the same embodiment, but may. Furthermore, the particular features, structures or characteristics may be combined in any suitable manner, as would be apparent to a person skilled in the art from this disclosure, in one or more embodiments. Furthermore, while some embodiments described herein include some but not other features included in other embodiments, combinations of features of different embodiments are meant to be within the scope of the invention, and form different embodiments, as would be understood by those in the art. For example, in the appended claims, any of the claimed embodiments can be used in any combination.

In the following detailed description of the invention, reference is made to the accompanying drawings that form a part hereof, and in which are shown by way of illustration only of specific embodiments in which the invention may be practiced. It is to be understood that other embodiments may be utilized and structural or logical changes may be made without departing from the scope of the present invention. The following detailed description, therefore, is not to be taken in a limiting sense, and the scope of the present invention is defined by the appended claims.

The following terms or definitions are provided solely to aid in the understanding of the invention. Unless specifically defined herein, all terms used herein have the same meaning as they would to one skilled in the art of the present invention. Practitioners are particularly directed to Sambrook et al., Molecular Cloning: A Laboratory Manual, 2nd ed., Cold Spring Harbor Press, Plainsview, N.Y. (1989); and Ausubel et al., Current Protocols in Molecular Biology (Supplement 47), John Wiley & Sons, New York (1999), Innis et al., PCR Protocols: A Guide to Methods and Applications, Academic Press: San Diego, 1990. General principles of microbiology are set forth, for example, in Davis, B. D. et al., Microbiology, 3rd edition, Harper & Row, publishers, Philadelphia, Pa. (1980), for definitions and terms of the art. The definitions provided herein should not be construed to have a scope less than understood by a person of ordinary skill in the art.

Unless indicated otherwise, all methods, steps, techniques and manipulations that are not specifically described in detail can be performed and have been performed in a manner known per se, as will be clear to the skilled person. Reference is for example again made to the standard handbooks, to the general background art referred to above and to the further references cited therein.

In an aspect, the invention relates to a (possibly in vitro) method for preparing a DNA targeting agent suitable for the treatment of cancer, preferably a cancer type having one or more cancer-specific sequence variation, such as copy number driven cancer types, or cancer having one or more cancer-specific (single nucleotide) polymorphism or one or more cancer-specific genomic insertion, deletion, or indel, said method comprising identifying a cancer-specific sequence variation, such as an amplified DNA region in a subject or a biological sample from a subject, or disease derived cells therefrom, such as in cancer cells of said cancer type, or one or more cancer-specific (single nucleotide) polymorphism or one or more cancer-specific genomic insertion, deletion, or indel; and producing a sequence-specific DNA targeting agent targeting a sequence comprising or comprised in said cancer-specific sequence variation. The biological sample may for instance be a tumor biopsy, but also includes cell lines derived from the tumor (biopsy).

In another aspect, the invention relates to a (possibly in vitro) method of identifying a biomarker indicative of susceptibility of a patient to treatment with a DNA targeting agent said method comprising (i) identifying one or more cancer-specific sequence variation, such as copy number variations (CNV), or one or more cancer-specific (single nucleotide) polymorphism or one or more cancer-specific genomic insertion, deletion, or indel within a population of patients treated with said DNA targeting agent and (ii) identifying patients susceptible to said treatment and (iii) thereby identifying cancer-specific sequence variation(s) as a biomarker. The identification may be on samples of the patient, which may for instance be a tumor biopsy, but also includes cell lines derived from the tumor (biopsy). Susceptibility towards treatment can be assessed by any technique or means known in the art. In general, susceptibility is associated with and hence can be assessed by at least one or more of tumor growth reduction or tumor cell growth reduction, tumor shrinkage or regression, tumor cell cycle arrest, tumor cell death, etc.

In another aspect, the invention relates to a (possibly in vitro) method for determining the susceptibility of a patient to treatment with a DNA targeting agent said method comprising (i) identifying in a sample of a patient the presence of one or more cancer-specific sequence variation, such as amplified DNA regions, or one or more cancer-specific (single nucleotide) polymorphism or one or more cancer-specific genomic insertion, deletion, or indel; and presence of a cancer-specific biomarker indicative of a cancer-specific sequence variation and (ii) determining based thereon whether or not said patient is susceptible to said treatment. The sample of the patient may for instance be a tumor biopsy, but also includes cell lines derived from the tumor (biopsy).

In another aspect, the invention relates to a (possibly in vitro) method for identifying a target DNA sequence for the development of an anti-proliferative agent, said method comprising (i) selectively generating DNA damage in the genome of a cancer cell, (ii) determining whether or not said DNA damage affects cell proliferation or viability (iii), identifying one or more discrete vulnerability regions within said genome for which said DNA damage affects cell proliferation or viability and (iv) identifying a DNA sequence within said one or more vulnerability regions as said target sequence. The cancer cell may for instance be a tumor biopsy, but also includes cell lines derived from the tumor (biopsy).

In an aspect, the invention relates to a sequence-specific DNA targeting agent, wherein the sequence-specific DNA targeting agent targets a cancer-specific sequence variation, such as a sequence within a DNA copy number variation (CNV) resulting from an amplification, or one or more cancer-specific (single nucleotide) polymorphism or one or more cancer-specific genomic insertion, deletion, or indel. In certain embodiments, the invention relates to a pharmaceutical composition comprising such sequence-specific DNA targeting agent.

In an aspect, the invention relates to the use of a sequence specific DNA targeting agent as defined herein, or a pharmaceutical composition as defined herein for treating, alleviating, reducing, or preventing a disease or disorder characterized by one or more cancer-specific sequence variation, such as DNA copy number variations (CNV), preferably a DNA copy number variation (CNV) resulting from an amplification, or one or more cancer-specific (single nucleotide) polymorphism or one or more cancer-specific genomic insertion, deletion, or indel. In certain embodiments, said disease is cancer.

In a related aspect, the invention provides in a method for treating, alleviating, reducing, or preventing a disease or disorder characterized by one or more cancer-specific sequence variation, such as DNA copy number variations (CNV), preferably a DNA copy number variation (CNV) resulting from an amplification, or one or more cancer-specific (single nucleotide) polymorphism or one or more cancer-specific genomic insertion, deletion, or indel; comprising administering to a subject in need thereof a sequence specific DNA targeting agent as defined herein, or a pharmaceutical composition as defined herein.

In a further related aspect, the invention provides in a sequence-specific DNA targeting agent a pharmaceutical composition comprising such sequence-specific DNA targeting agent, wherein the sequence-specific DNA targeting agent targets a one or more cancer-specific sequence variation, such as a sequence within a DNA copy number variation (CNV) resulting from an amplification, or one or more cancer-specific (single nucleotide) polymorphism or one or more cancer-specific genomic insertion, deletion, or indel, for use in treating, alleviating, reducing, or preventing a disease characterized by DNA copy number variation (CNV), preferably resulting from an amplification, or characterized by one or more cancer-specific (single nucleotide) polymorphism or one or more cancer-specific genomic insertion, deletion, or indel.

It will be understood by the skilled person, that treatment with the DNA targeting agent as described herein may be combined with further treatments, which may be administered or applied simultaneously, sequentially, or subsequently. In certain embodiments, the treatment methods according to the invention may be combined with known cancer treatments, including the use of chemotherapeutics, anti-angiogenesis agents, or agents reducing immune-suppression. In certain embodiments, the combined treatment does not act directly on the tumor, but acts on the tumor (micro-)environment, such as anti-angiogenesis agents or agents that reduce immune suppression.

The present invention allows to specifically amplify in cells having one or more cancer-specific sequence variation, such as DNA amplifications, in particular cancer cells, or having one or more cancer-specific (single nucleotide) polymorphism or one or more cancer-specific genomic insertion, deletion, or indel, therapeutic agent retention by means of specifically targeting such agents to these cancer-specific DNA regions. Coupling of a therapeutic agent, being it a DNA damaging agent, a cytotoxic agent, and anti-proliferative agent etc. to a DNA targeting agent which specifically recognizes and binds to these cancer-specific DNA regions, in particular specific for cancer cells, results in an increased concentration of such therapeutic agent specifically in cancer cells. Such specific concentration of therapeutic agents in cancer cells may allow for reducing dosage, and hence minimize off-target effects, or at least may reduce by virtue of cancer-cell specificity the presence or therapeutic agent in non-target cells.

As used herein, the term “DNA targeting agent” refers to an agent which binds to DNA, most preferably in a sequence specific manner. In certain embodiments, the targeting agent specifically and exclusively binds to DNA. In certain other embodiments, the targeting agent does not specifically or exclusively bind DNA. In certain embodiments, the DNA targeting agent comprises DNA or RNA (such as gRNA). In certain embodiments, the DNA targeting agent may comprise a DNA damaging agent, a cytotoxic agent, or an anti-proliferative agent.

As used herein, the term “DNA damaging agent” refers to an agent which introduces non-physiological modifications in or to DNA. Such modifications include among others DNA strand breaks, which may be single strand breaks or double strand breaks. In general, the modifications as referred to herein are those which under normal physiological conditions induce DNA repair, such as NHEJ, or which in the alternative may induce cell cycle arrest or cell death, such as apoptosis.

As used herein, the term “cancer-specific sequence variation” refers to a DNA sequence, which may be of any length, and includes for instance also single nucleotides, which is characteristic of or is only present in cancer cells. It will be understood by the skilled person that some DNA regions naturally have DNA sequence variations, without being associated with proliferative diseases or disorders, such as for instance cancer. Accordingly, in certain embodiments, the cancer-specific sequence variation is specific for cancer cells or pre-cancerous cells, and thus does not occur in non-(pre-)cancerous cells. Comparison with the corresponding sequence of a non-cancer cell allows the identification of cancer-specificity. It will be understood by the skilled person, that while the cancer-specific sequence variation is typical for cancer cells, such does not necessarily imply that a (cancer) specific phenotype is associated witch such sequence variation. Hence, the cancer-specific sequence variation may or may not be associated with a specific phenotype (e.g. a cancer-specific phenotype). In particular, when the cancer-specific sequence variation resides in, or does not encompass coding sequences (or regulatory sequences), such sequence may very well not be associated with a particular phenotype (but not necessaryly). On the other hand, if the cancer-specific sequence variation resides in or is associated with a coding sequence (or regulatory sequence), such sequence may very well be associated with a particular phenotype (but not necessarily). The cancer-specific sequence variation may be any type of sequence variation. By means of example, and without limitation, the cancer-specific sequence variation as referred to herein may be mutations in coding regions of genes, such as frameshift mutations, nonsense mutations, missense mutations, neutral mutations, or silent mutations. Alternatively, the cancer-specific sequence variations as referred to herein may be mutations outside coding sequences of genes, such as in intron sequences or intergenic sequences, or may or may not be in regulatory sequences, such as promoters, enhancers, silencers, insulators, etc., The cancer-specific sequence variations as referred to herein may be loss-of-function mutations, gain-of function mutations, dominant negative mutations, neutral mutations, etc. The cancer-specific sequence variations as referred to herein may result from amplifications or gene duplications, or alternatively from deletions; or may be the result of for instance chromosomal translocations or inversions. Entire chromosome segments may be associated with the cancer-specific sequence variation as referred to herein. Alternatively, smaller DNA fragments may be associated with the cancer-specific sequence variations as referred to herein, such as including, but not limited to for instance polymorphisms, such as single nucleotide mutations or for instance indels (of any size). The cancer-specific sequence variations as referred to herein may be for instance a single nucleotide polymorphism (SNP), which may occur in coding or non-coding regions of genes, or regulatory sequences associated with genes (and may or may not affect gene product function, including splicing, mRNA stability, etc.), or may alternatively occur in intergenic regions. Cancer-specific sequence variations can be discovered by techniques known in the art, such as without limitation cytogenetic techniques such as fluorescent in situ hybridization, comparative genomic hybridization, array comparative genomic hybridization, end-sequence profiling and by virtual karyotyping with SNP arrays. Advantageously, a large number of cancer-specific sequence variations, or diverse types and origins, are know to date. Various databases can in this context be consulted to identify or retrieve cancer-specific sequence variations. By means of example, and without limitation, the following databases may be online consulted to identify or retrieve cancer-specific sequence variations: OMIM (Online Mendelian inheritance in Man; www.ncbi.nlm.nih.gov/omim), DSD (Database of SNP associated disease; www.academia.edu/8436280/DSD_A_DATABASE_OF_SNP_ASSOCIATED_DISEASES), SCAN (SNP and CNV annotation database; www.scandb.org/newinterface/about.html), CaSNP (Cancer SNP database; www.hsls.pitt. edu/obrc/index.php?page=URL20110523142833), DoCM (Database of curated mutations; docm.genome.wustl.edu/), CIVIC (clinical interpretations of variants in cancer; civic.genome.wustl.edu/#/home); COSMIC (Catalogue of somatic mutations in cancer; cancer.sanger.ac.uk/cosmic); ClinVar (www.ncbi.nlm.nih.gov/clinvar/), Cancer Genome Atlas (https://tcga-data.nci.nih.gov/tcga/).

As used herein, the term “DNA copy number variation” refers to an alteration of normal copy number of such DNA (sequence or segment), such as resulting in a cell (or cells) having an abnormal or, for certain genes, a normal variation in the number of copies of one or more sections of the DNA. In certain embodiments, the DNA copy number variation as described herein results from DNA (sequence or segment) amplification, i.e. multiple copies are present in the genome. Copy number variation can be discovered by techniques known in the art, such as without limitation cytogenetic techniques such as fluorescent in situ hybridization, comparative genomic hybridization, array comparative genomic hybridization, end-sequence profiling and by virtual karyotyping with SNP arrays. Recent advances in DNA sequencing technology have further enabled the identification of CNVs by next-generation sequencing. It will be understood by the skilled person that some DNA regions naturally have DNA copy number variations, without being associated with proliferative diseases or disorders, such as for instance cancer. Accordingly, in certain embodiments, the DNA copy number variation, such as in particular resulting from DNA amplification is specific for cancer cells or pre-cancerous cells, and thus does not occur in non-(pre-)cancerous cells.

As used herein, the term “copy number driven disease” refers to a disease, such as cancer, which results from or is otherwise pathologically associated with an altered copy number of specific DNA segments. It is to be understood that copy number driven diseases may encompass DNA amplification of DNA segments wherein the DNA segment includes a larger portion of DNA (e.g. more genes) than strictly necessary to drive the copy number driven disease. By means of example, for instance an amplified DNA segment may comprise a single oncogene (which is thus amplified), but may also comprise, otherwise unrelated, flanking DNA segments (possibly additional genes), which are not (necessarily) involved in the pathological condition.

In certain embodiments, the copy number driven disease as referred to herein is a proliferative disease. In certain embodiments, the copy number driven disease as referred to herein or the proliferative disease referred to herein is cancer, i.e. cancer characterized by DNA copy number variation, in particular DNA (segment) amplification.

As used herein, the term “amplification” in the context of DNA copy number variations, preferentially refers to an increase in copy number of certain (genomic) DNA fragments or segments in a diseased subject, or a subject prone to disease, such as cancer, compared to a non-diseased subject, or a subject not prone to disease, such as cancer. It is to be understood that amplification of DNA as referred to herein includes but is not restricted to gene amplification. Amplification of (genomic) DNA sequences or segments also includes amplification of sequences not comprising genes or coding sequences, or not exclusively comprising genes or coding sequences. Method for detecting DNA amplification are known in the art, and include without limitation sequence analysis, FRLP, AFLP, FISH, PCR, in particular genomic qPCR, hybridization, etc as also described herein elsewhere. Analyzing DNA amplification may for instance include comparison of a sample suspected of having a particular DNA amplification with a samples known not to contain such DNA amplification (i.e. control samples). Control samples may be samples from the same subject, but not originating from the disease tissue, such as not originating from the tumor or tumor cells. Alternatively, control samples may originate from a different source, such as without limitation a database.

As used herein, the term “biomarker” refers to a DNA segment which is characteristically present in a disease state and thus can be used to identify the disease state and which is characteristic for treatment susceptibility of a subject with a DNA targeting agent as defined herein.As used herein, the term “amplicon biomarker” refers to a DNA segment which is characteristically amplified in a disease state and thus can be used to identify the disease state and which is characteristic for treatment susceptibility of a subject with a DNA targeting agent as defined herein. Susceptibility of treatment with a DNA targeting agent as defined herein may for instance be established by appropriate in vitro cell proliferation or cell viability assays as are generally known in the art.

As used herein, the term “vulnerability region” refers to a DNA target region in which DNA damage results in decreased cell viability and/or deceased cell proliferation. In more general terms, targeting a vulnerability region preferably detrimentally affects tumor development, growth, progression, and or survival.

As used herein, the term “sequence specific for a cancer cell” refers to any DNA sequence that is present in a cancer cell and not in a normal cell in a subject. The sequence may for instance be a cancer specific single nucleotide polymorphism, insertion, deletion, indel, or otherwise mutated sequence, including copy number variations. The term “sequence specific for a cancer cell” may be used herein interchangeably with “cancer-specific sequence variation”. It is to be understood in this context, that for instance in the case of amplifications, while a normal cell also comprises a single copy of the target sequence, such sequence nevertheless is considered cancer-specific by virtue of its increased copy number.

By means of example, and without limitation, the DNA targeting agent as described herein may comprise a nuclease which may be directed in a sequence specific manner to a DNA region to be targeted. In certain embodiments, the DNA targeting agent may comprise a CRISPR/Cas system, a Zinc finger nuclease (ZFN), Transcription Activator-Like Effector Nuclease (TALEN), or meganuclease; as defined herein elsewhere.

In certain embodiments, the DNA targeting agent may comprise a DNA damaging agent, a cytotoxic agent, and/or an antiproliferative-agent. in certain embodiments, the DNA targeting agent may comprise radio-active isotope, DNA cross-linker, topoisomerase inhibitor, or DNA intercalation agent. Suitable radioactive isotopes (radionuclides) include Lead-212, Bismuth-212, Astatine-211, Iodine-131, Scandium-47, Rhenium-186, Rhenium-188, Yttrium-90, Iodine-123, Iodine-125, Bromine-77, Indium-111, Erbium-169, Strontium-89, Samarium-153, Phosphorus-32. DNA cross-linkers may for instance include alkylating agents (e.g. 1,3-bis(2-chloroethyl)-1-nitrosourea) or platinum-based DNA crosslinkers (e.g. cisplatin). Topoisomerase inhibitors may include topoisomerase I inhibitors (e.g. irinotecan, topotecan, camptothecin and lamellarin D) and topoisomerase II inhibitors (e.g. etoposide (VP-16), teniposide, doxorubicin, daunorubicin, mitoxantrone, amsacrine, ellipticines, aurintricarboxylic acid, and HU-331). DNA intercalating agents for instance include dactinomycin, berberine, proflavine, daunomycin, doxorubicin, and thalidomide.

In certain embodiments, the DNA targeting agent according to the invention as described herein comprises an anti-cancer agent, for example an anti-cancer agent listed on www.cancer.gov/about-cancer/treatment/drugs. In certain embodiment, the DNA targeting agent comprises one or more of an anti-cancer agent selected from the group comprising or consisting of Abiraterone Acetate, Abitrexate (Methotrexate), Abraxane (Paclitaxel Albumin-stabilized Nanoparticle Formulation), ABVD, ABVE, ABVE-PC, AC, AC-T, Adcetris (Brentuximab Vedotin), ADE, Ado-Trastuzumab Emtansine, Adriamycin (Doxorubicin Hydrochloride), Adrucil (Fluorouracil), Afatinib Dimaleate, Afinitor (Everolimus), Akynzeo (Netupitant and Palonosetron Hydrochloride), Aldara (Imiquimod), Aldesleukin, Alemtuzumab, Alimta (Pemetrexed Disodium), Aloxi (Palonosetron Hydrochloride), Ambochlorin (Chlorambucil), Amboclorin (Chlorambucil), Aminolevulinic Acid, Anastrozole, Aprepitant, Aredia (Pamidronate Disodium), Arimidex (Anastrozole), Aromasin (Exemestane), Arranon (Nelarabine), Arsenic Trioxide, Arzerra (Ofatumumab), Asparaginase Erwinia chrysanthemi, Avastin (Bevacizumab), Axitinib, Azacitidine, BEACOPP, Becenum (Carmustine), Beleodaq (Belinostat), Belinostat, Bendamustine Hydrochloride, BEP, Bevacizumab, Bexarotene, Bexxar (Tositumomab and Iodine I 131 Tositumomab), Bicalutamide, BiCNU (Carmustine), Bleomycin, Blinatumomab, Blincyto (Blinatumomab), Bortezomib, Bosulif (Bosutinib), Bosutinib, Brentuximab Vedotin, Busulfan, Busulfex (Busulfan), Cabazitaxel, Cabozantinib-S-Malate, CAF, Campath (Alemtuzumab), Camptosar (Irinotecan Hydrochloride), Capecitabine, CAPDX, Carboplatin, CARBOPLATIN-TAXOL, Carfilzomib, Carmubris (Carmustine), Carmustine, Carmustine Implant, Casodex (Bicalutamide), CeeNU (Lomustine), Ceritinib, Cerubidine (Daunorubicin Hydrochloride), Cervarix (Recombinant HPV Bivalent Vaccine), Cetuximab, Chlorambucil, CHLORAMBUCIL-PREDNISONE, CHOP, Cisplatin, Clafen (Cyclophosphamide), Clofarabine, Clofarex (Clofarabine), Clolar (Clofarabine), CMF, Cometriq (Cabozantinib-S-Malate), COPDAC, COPP, COPP-ABV, Cosmegen (Dactinomycin), Crizotinib, CVP, Cyclophosphamide, Cyfos (Ifosfamide), Cyramza (Ramucirumab), Cytarabine, Cytarabine, Liposomal, Cytosar-U (Cytarabine), Cytoxan (Cyclophosphamide), Dabrafenib, Dacarbazine, Dacogen (Decitabine), Dactinomycin, Dasatinib, Daunorubicin Hydrochloride, Decitabine, Degarelix, Denileukin Diftitox, Denosumab, DepoCyt (Liposomal Cytarabine), DepoFoam (Liposomal Cytarabine), Dexamethasone, Dexrazoxane Hydrochloride, Dinutuximab, Docetaxel, Doxil (Doxorubicin Hydrochloride Liposome), Doxorubicin Hydrochloride, Doxorubicin Hydrochloride Liposome, Dox-SL (Doxorubicin Hydrochloride Liposome), DTIC-Dome (Dacarbazine), Efudex (Fluorouracil), Elitek (Rasburicase), Ellence (Epirubicin Hydrochloride), Eloxatin (Oxaliplatin), Eltrombopag Olamine, Emend (Aprepitant), Enzalutamide, Epirubicin Hydrochloride, EPOCH, Erbitux (Cetuximab), Eribulin Mesylate, Erivedge (Vismodegib), Erlotinib Hydrochloride, Erwinaze (Asparaginase Erwinia chrysanthemi), Etopophos (Etoposide Phosphate), Etoposide, Etoposide Phosphate, Evacet (Doxorubicin Hydrochloride Liposome), Everolimus, Evista (Raloxifene Hydrochloride), Exemestane, 5-FU (Fluorouracil), Fareston (Toremifene), Farydak (Panobinostat), Faslodex (Fulvestrant), FEC, Femara (Letrozole), Filgrastim, Fludara (Fludarabine Phosphate), Fludarabine Phosphate, Fluoroplex (Fluorouracil), Fluorouracil, Folex (Methotrexate), Folex PFS (Methotrexate), FOLFIRI, FOLFIRI-BEVACIZUMAB, FOLFIRI-CETUXIMAB, FOLFIRINOX, FOLFOX, Folotyn (Pralatrexate), FU-LV, Fulvestrant, Gardasil (Recombinant HPV Quadrivalent Vaccine), Gardasil 9 (Recombinant HPV Nonavalent Vaccine), Gazyva (Obinutuzumab), Gefitinib, Gemcitabine Hydrochloride, GEMCITABINE-CISPLATIN, GEMCITABINE-OXALIPLATIN, Gemtuzumab Ozogamicin, Gemzar (Gemcitabine Hydrochloride), Gilotrif (Afatinib Dimaleate), Gleevec (Imatinib Mesylate), Gliadel (Carmustine Implant), Gliadel wafer (Carmustine Implant), Glucarpidase, Goserelin Acetate, Halaven (Eribulin Mesylate), Herceptin (Trastuzumab), HPV Bivalent Vaccine, Recombinant, HPV Nonavalent Vaccine, Recombinant, HPV Quadrivalent Vaccine, Recombinant, Hycamtin (Topotecan Hydrochloride), Hyper-CVAD, Ibrance (Palbociclib), Ibritumomab Tiuxetan, Ibrutinib, ICE, Iclusig (Ponatinib Hydrochloride), Idamycin (Idarubicin Hydrochloride), Idarubicin Hydrochloride, Idelalisib, Ifex (Ifosfamide), Ifosfamide, Ifosfamidum (Ifosfamide), IL-2 (Aldesleukin), Imatinib Mesylate, Imbruvica (Ibrutinib), Imiquimod, Inlyta (Axitinib), Interferon Alfa-2b, Recombinant, Interleukin-2 (Aldesleukin), Intron A (Recombinant Interferon Alfa-2b), Iodine I 131 Tositumomab and Tositumomab, Ipilimumab, Iressa (Gefitinib), Irinotecan Hydrochloride, Istodax (Romidepsin), Ixabepilone, Ixempra (Ixabepilone), Jakafi (Ruxolitinib Phosphate), Jevtana (Cabazitaxel), Kadcyla (Ado-Trastuzumab Emtansine), Keoxifene (Raloxifene Hydrochloride), Kepivance (Palifermin), Keytruda (Pembrolizumab), Kyprolis (Carfilzomib), Lanreotide Acetate, Lapatinib Ditosylate, Lenalidomide, Lenvatinib Mesylate, Lenvima (Lenvatinib Mesylate), Letrozole, Leucovorin Calcium, Leukeran (Chlorambucil), Leuprolide Acetate, Levulan (Aminolevulinic Acid), Linfolizin (Chlorambucil), LipoDox (Doxorubicin Hydrochloride Liposome), Liposomal Cytarabine, Lomustine, Lonsurf (Trifluridine and Tipiracil Hydrochloride), Lupron (Leuprolide Acetate), Lupron Depot (Leuprolide Acetate), Lupron Depot-Ped (Leuprolide Acetate), Lupron Depot-3 Month (Leuprolide Acetate), Lupron Depot-4 Month (Leuprolide Acetate), Lynparza (Olaparib), Marqibo (Vincristine Sulfate Liposome), Matulane (Procarbazine Hydrochloride), Mechlorethamine Hydrochloride, Megace (Megestrol Acetate), Megestrol Acetate, Mekinist (Trametinib), Mercaptopurine, Mesna, Mesnex (Mesna), Methazolastone (Temozolomide), Methotrexate, Methotrexate LPF (Methotrexate), Mexate (Methotrexate), Mexate-AQ (Methotrexate), Mitomycin C, Mitoxantrone Hydrochloride, Mitozytrex (Mitomycin C), MOPP, Mozobil (Plerixafor), Mustargen (Mechlorethamine Hydrochloride), Mutamycin (Mitomycin C), Myleran (Busulfan), Mylosar (Azacitidine), Mylotarg (Gemtuzumab Ozogamicin), Nanoparticle Paclitaxel (Paclitaxel Albumin-stabilized Nanoparticle Formulation), Navelbine (Vinorelbine Tartrate), Nelarabine, Neosar (Cyclophosphamide), Netupitant and Palonosetron Hydrochloride, Neupogen (Filgrastim), Nexavar (Sorafenib Tosylate), Nilotinib, Nivolumab, Nolvadex (Tamoxifen Citrate), Nplate (Romiplostim), Obinutuzumab, Odomzo (Sonidegib), OEPA, Ofatumumab, OFF, Olaparib, Omacetaxine Mepesuccinate, Oncaspar (Pegaspargase), Ondansetron Hydrochloride, Ontak (Denileukin Diftitox), Opdivo (Nivolumab), OPPA, Oxaliplatin, Paclitaxel, Paclitaxel Albumin-stabilized Nanoparticle Formulation, PAD, Palbociclib, Palifermin, Palonosetron Hydrochloride, Palonosetron Hydrochloride and Netupitant, Pamidronate Disodium, Panitumumab, Panobinostat, Paraplat (Carboplatin), Paraplatin (Carboplatin), Pazopanib Hydrochloride, PCV, Pegaspargase, Peginterferon Alfa-2b, PEG-Intron (Peginterferon Alfa-2b), Pembrolizumab, Pemetrexed Disodium, Perjeta (Pertuzumab), Pertuzumab, Platinol (Cisplatin), Platinol-AQ (Cisplatin), Plerixafor, Pomalidomide, Pomalyst (Pomalidomide), Ponatinib Hydrochloride, Pralatrexate, Prednisone, Procarbazine Hydrochloride, Proleukin (Aldesleukin), Prolia (Denosumab), Promacta (Eltrombopag Olamine), Provenge (Sipuleucel-T), Purinethol (Mercaptopurine), Purixan (Mercaptopurine), Radium 223 Dichloride, Raloxifene Hydrochloride, Ramucirumab, Rasburicase, R-CHOP, R-CVP, Recombinant Human Papillomavirus (HPV) Bivalent Vaccine, Recombinant Human Papillomavirus (HPV) Nonavalent Vaccine, Recombinant Human Papillomavirus (HPV) Quadrivalent Vaccine, Recombinant Interferon Alfa-2b, Regorafenib, R-EPOCH, Revlimid (Lenalidomide), Rheumatrex (Methotrexate), Rituxan (Rituximab), Rituximab, Rolapitant Hydrochloride, Romidepsin, Romiplostim, Rubidomycin (Daunorubicin Hydrochloride), Ruxolitinib Phosphate, Sclerosol Intrapleural Aerosol (Talc), Siltuximab, Sipuleucel-T, Somatuline Depot (Lanreotide Acetate), Sonidegib, Sorafenib Tosylate, Sprycel (Dasatinib), STANFORD V, Sterile Talc Powder (Talc), Steritalc (Talc), Stivarga (Regorafenib), Sunitinib Malate, Sutent (Sunitinib Malate), Sylatron (Peginterferon Alfa-2b), Sylvant (Siltuximab), Synovir (Thalidomide), Synribo (Omacetaxine Mepesuccinate), Tabloid (Thioguanine), TAC, Tafinlar (Dabrafenib), Talc, Tamoxifen Citrate, Tarabine PFS (Cytarabine), Tarceva (Erlotinib Hydrochloride), Targretin (Bexarotene), Tasigna (Nilotinib), Taxol (Paclitaxel), Taxotere (Docetaxel), Temodar (Temozolomide), Temozolomide, Temsirolimus, Thalidomide, Thalomid (Thalidomide), Thioguanine, Thiotepa, Toposar (Etoposide), Topotecan Hydrochloride, Toremifene, Torisel (Temsirolimus), Tositumomab and Iodine I 131 Tositumomab, Totect (Dexrazoxane Hydrochloride), TPF, Trametinib, Trastuzumab, Treanda (Bendamustine Hydrochloride), Trifluridine and Tipiracil Hydrochloride, Trisenox (Arsenic Trioxide), Tykerb (Lapatinib Ditosylate), Unituxin (Dinutuximab), Vandetanib, VAMP, Varubi (Rolapitant Hydrochloride), Vectibix (Panitumumab), VeIP, Velban (Vinblastine Sulfate), Velcade (Bortezomib), Velsar (Vinblastine Sulfate), Vemurafenib, VePesid (Etoposide), Viadur (Leuprolide Acetate), Vidaza (Azacitidine), Vinblastine Sulfate, Vincasar PFS (Vincristine Sulfate), Vincristine Sulfate, Vincristine Sulfate Liposome, Vinorelbine Tartrate, VIP, Vismodegib, Voraxaze (Glucarpidase), Vorinostat, Votrient (Pazopanib Hydrochloride), Wellcovorin (Leucovorin Calcium), Xalkori (Crizotinib), Xeloda (Capecitabine), XELIRI, XELOX, Xgeva (Denosumab), Xofigo (Radium 223 Dichloride), Xtandi (Enzalutamide), Yervoy (Ipilimumab), Zaltrap (Ziv-Aflibercept), Zarxio (Filgrastim), Zelboraf (Vemurafenib), Zevalin (Ibritumomab Tiuxetan), Zinecard (Dexrazoxane Hydrochloride), Ziv-Aflibercept, Zofran (Ondansetron Hydrochloride), Zoladex (Goserelin Acetate), Zoledronic Acid, Zolinza (Vorinostat), Zometa (Zoledronic Acid), Zydelig (Idelalisib), Zykadia (Ceritinib), Zytiga (Abiraterone Acetate).

It is to be understood that the DNA targeting agents according to the invention as described herein may advantageously be used in the methods as described herein, wherein these are introduced in cells having cancer-specific sequence variations, such as DNA copy number variations, preferably resulting from DNA amplification, wherein the cells are cancer cells, or one or more cancer-specific (single nucleotide) polymorphism or one or more cancer-specific genomic insertion, deletion, or indel. The cells however, need not necessarily be cancer cells. Also precancerous cells are envisaged, such as cell having DNA copy number variations, preferably DNA amplifications, which are not yet cancer cells, but may yet develop into cancer cells. Accordingly, in certain embodiments, the present invention also relates to methods for preventing cancer comprising administering the DNA targeting agent as described herein to a subject having a cancer-specific sequence variations, such as a DNA copy number variation, preferably resulting from DNA amplification, or one or more (pre-)cancer-specific (single nucleotide) polymorphism or one or more (pre-)cancer-specific genomic insertion, deletion, or indel.

In certain embodiments, the sequence specific DNA targeting agent comprises a probe, which may be a DNA or RNA probe, which confers sequence specificity. The probe may for instance serve to target a nuclease to the specific DNA site, such as for instance is the case in the CRISPR/Cas system.

In certain embodiments, the DNA targeting agent is modular, and comprises a module responsible for DNA specific targeting, such as a guide RNA in case of the CRISPR/Cas system, and further comprises a module responsible for inducing DNA damage, such as a nuclease, such as Cas in case of the CRISPR/Cas system. However, alternative DNA damaging agents may be provided on or in, or may be associated with, or induced to associate with, the DNA targeting moiety. Examples include for instance one or more radio-active isotope, DNA cross-linker, topoisomerase inhibitor, or DNA intercalation agent, or combinations thereof. Alternatively, the module for DNA specific targeting may be complemented with for instance an anti-proliferative agent, or a cytotoxic agent, or more general an anti-cancer agent or an agent involved in tumor suppression, regression, inhibition, etc., such as without limitation chemotherapeutic agents, anti-angiogenesis agents and agents that reduce immune-suppression. Such agents may be covalently or non-covalently coupled to the targeting agent. By means of example, radionuclides, chemotherapeutics, etc. may be integrated in the targeting agent, and may or may not be coupled to the targeting agent by appropriate linkers.

In certain embodiments, the DNA targeting agent as described herein targets a coding sequence, which may be a protein coding sequence as well as an RNA coding sequence (such as for instance miRNA).

In certain other embodiments, the DNA targeting agent as described herein targets a non-coding coding sequence. In an embodiment, the DNA targeting agent targets a non-coding DNA sequence (e.g. non-protein coding sequence or non-RNA coding sequence) associated with a gene, such as a regulatory sequence or an intron. In certain other embodiments, the DNA targeting agent targets a non-coding DNA sequence, which is not associated with a gene, such as an intergenic DNA sequence or DNA sequences within or associated with pseudogenes. In certain embodiments, the DNA targeting agent does not target a regulatory sequence (e.g. promoter, enhancer, silencer, insulator, etc.) or an intron of a gene. In certain embodiments, the DNA targeting agent does not target the 5′ and/or 3′ UTR of a gene. In certain embodiments, the DNA targeting agent targets a phenotypically neutral sequence.

In certain embodiments, the DNA targeting agent as described herein targets a (coding or non-coding) sequence of a non-essential gene. The skilled person will understand the meaning of the term “non-essential” gene. By means of further guidance, a non-essential gene is a gene the deletion thereof or the suppression of the function thereof which does not result in cell death or otherwise detrimentally affects normal physiological cell function.

In certain embodiments, the DNA targeting agent as described herein does not target an oncogene. In certain embodiments, the DNA targeting agent as described herein does not target a DNA sequence (or gene) causally associated with tumorigenesis.

In certain embodiments, the methods as described herein (including screening, identification, and therapeutic methods) involve a multiplexed DNA targeting agent. in such embodiments, multiple different DNA targeting agents as described herein are used in these methods. For instance, at least 2, 3, 4, 5, 6, 7, 8, 9, 10, or more different DNA targeting agents (i.e. DNA targeting agents targeting a different cancer-specific sequence variation) may be used in the methods as described herein. These multiple targeting agents may be used or administered simultaneously or sequentially, preferably simultaneously.

With respect to general information on CRISPR-Cas Systems, components thereof, and delivery of such components, including methods, materials, delivery vehicles, vectors, particles, AAV, and making and using thereof, including as to amounts and formulations, all useful in the practice of the instant invention, reference is made to: U.S. Pat. Nos. 8,999,641, 8,993,233, 8,945,839, 8,932,814, 8,906,616, 8,895,308, 8,889,418, 8,889,356, 8,871,445, 8,865,406, 8,795,965, 8,771,945 and 8,697,359; US Patent Publications US 2014-0310830 (US APP. Ser. No. 14/105,031), US 2014-0287938 A1 (U.S. application Ser. No. 14/213,991), US 2014-0273234 A1 (U.S. application Ser. No. 14/293,674), US2014-0273232 A1 (U.S. application Ser. No. 14/290,575), US 2014-0273231 (U.S. application Ser. No. 14/259,420), US 2014-0256046 A1 (U.S. application Ser. No. 14/226,274), US 2014-0248702 A1 (U.S. application Ser. No. 14/258,458), US 2014-0242700 A1 (U.S. application Ser. No. 14/222,930), US 2014-0242699 A1 (U.S. application Ser. No. 14/183,512), US 2014-0242664 A1 (U.S. application Ser. No. 14/104,990), US 2014-0234972 A1 (U.S. application Ser. No. 14/183,471), US 2014-0227787 A1 (U.S. application Ser. No. 14/256,912), US 2014-0189896 A1 (U.S. application Ser. No. 14/105,035), US 2014-0186958 (U.S. application Ser. No. 14/105,017), US 2014-0186919 A1 (U.S. application Ser. No. 14/104,977), US 2014-0186843 A1 (U.S. application Ser. No. 14/104,900), US 2014-0179770 A1 (U.S. application Ser. No. 14/104,837) and US 2014-0179006 A1 (U.S. application Ser. No. 14/183,486), US 2014-0170753 (U.S. application Ser. No. 14/183,429); European Patents EP 2 784 162 B1 and EP 2 771 468 B1; European Patent Applications EP 2 771 468 (EP13818570.7), EP 2 764 103 (EP13824232.6), and EP 2 784 162 (EP14170383.5); and PCT Patent Publications PCT Patent Publications WO 2014/093661 (PCT/US2013/074743), WO 2014/093694 (PCT/US2013/074790), WO 2014/093595 (PCT/US2013/074611), WO 2014/093718 (PCT/US2013/074825), WO 2014/093709 (PCT/US2013/074812), WO 2014/093622 (PCT/US2013/074667), WO 2014/093635 (PCT/US2013/074691), WO 2014/093655 (PCT/US2013/074736), WO 2014/093712 (PCT/US2013/074819), WO2014/093701 (PCT/US2013/074800), WO2014/018423 (PCT/US2013/051418), WO 2014/204723 (PCT/US2014/041790), WO 2014/204724 (PCT/US2014/041800), WO 2014/204725 (PCT/US2014/041803), WO 2014/204726 (PCT/US2014/041804), WO 2014/204727 (PCT/US2014/041806), WO 2014/204728 (PCT/US2014/041808), WO 2014/204729 (PCT/US2014/041809). Reference is also made to U.S. provisional patent applications 61/758,468; 61/802,174; 61/806,375; 61/814,263; 61/819,803 and 61/828,130, filed on Jan. 30, 2013; Mar. 15, 2013; Mar. 28, 2013; Apr. 20, 2013; May 6, 2013 and May 28, 2013 respectively. Reference is also made to U.S. provisional patent application 61/836,123, filed on Jun. 17, 2013. Reference is additionally made to U.S. provisional patent applications 61/835,931, 61/835,936, 61/836,127, 61/836,101, 61/836,080 and 61/835,973, each filed Jun. 17, 2013. Further reference is made to U.S. provisional patent applications 61/862,468 and 61/862,355 filed on Aug. 5, 2013; 61/871,301 filed on Aug. 28, 2013; 61/960,777 filed on Sep. 25, 2013 and 61/961,980 filed on Oct. 28, 2013. Reference is yet further made to: PCT Patent applications Nos: PCT/US2014/041803, PCT/US2014/041800, PCT/US2014/041809, PCT/US2014/041804 and PCT/US2014/041806, each filed Jun. 10, 2014 6/10/14; PCT/US2014/041808 filed Jun. 11, 2014; and PCT/US2014/62558 filed Oct. 28, 2014, and U.S. Provisional Patent Applications Ser. Nos.: 61/915,150, 61/915,301, 61/915,267 and 61/915,260, each filed Dec. 12, 2013; 61/757,972 and 61/768,959, filed on Jan. 29, 2013 and Feb. 25, 2013; 61/835,936, 61/836,127, 61/836,101, 61/836,080, 61/835,973, and 61/835,931, filed Jun. 17, 2013; 62/010,888 and 62/010,879, both filed Jun. 11, 2014; 62/010,329 and 62/010,441, each filed Jun. 10, 2014; 61/939,228 and 61/939,242, each filed Feb. 12, 2014; 61/980,012, filed Apr. 15,2014; 62/038,358, filed Aug. 17, 2014; 62/054,490, 62/055,484, 62/055,460 and 62/055,487, each filed Sep. 25, 2014; and 62/069,243, filed Oct. 27, 2014. Reference is also made to U.S. provisional patent applications Nos. 62/055,484, 62/055,460, and 62/055,487, filed Sep. 25, 2014; U.S. provisional patent application 61/980,012, filed Apr. 15, 2014; and U.S. provisional patent application 61/939,242 filed Feb. 12, 2014. Reference is made to PCT application designating, inter alia, the United States, application No. PCT/US14/41806, filed Jun. 10, 2014.

Reference is made to U.S. provisional patent application 61/930,214 filed on Jan. 22, 2014. Reference is made to U.S. provisional patent applications 61/915,251; 61/915,260 and 61/915,267, each filed on Dec. 12, 2013. Reference is made to U.S. provisional patent application U.S. Ser. No. 61/980,012 filed Apr. 15, 2014. Reference is made to PCT application designating, inter alia, the United States, application No. PCT/US14/41806, filed Jun. 10, 2014. Reference is made to U.S. provisional patent application 61/930,214 filed on Jan. 22, 2014. Reference is made to U.S. provisional patent applications 61/915,251; 61/915,260 and 61/915,267, each filed on Dec. 12, 2013.

Mention is also made of U.S. application 62/091,455, filed, 12 Dec. 14, PROTECTED GUIDE RNAS (PGRNAS); U.S. application 62/096,708, 24 Dec. 14, PROTECTED GUIDE RNAS (PGRNAS); U.S. application 62/091,462, 12 Dec. 14, DEAD GUIDES FOR CRISPR TRANSCRIPTION FACTORS; U.S. application 62/096,324, 23 Dec. 14, DEAD GUIDES FOR CRISPR TRANSCRIPTION FACTORS; U.S. application 62/091,456, 12 Dec. 14, ESCORTED AND FUNCTIONALIZED GUIDES FOR CRISPR-CAS SYSTEMS; U.S. application 62/091,461, 12 Dec. 14, DELIVERY, USE AND THERAPEUTIC APPLICATIONS OF THE CRISPR-CAS SYSTEMS AND COMPOSITIONS FOR GENOME EDITING AS TO HEMATOPOETIC STEM CELLS (HSCs); U.S. application 62/094,903, 19 Dec. 14, UNBIASED IDENTIFICATION OF DOUBLE-STRAND BREAKS AND GENOMIC REARRANGEMENT BY GENOME-WISE INSERT CAPTURE SEQUENCING; U.S. application 62/096,761, 24 Dec. 14, ENGINEERING OF SYSTEMS, METHODS AND OPTIMIZED ENZYME AND GUIDE SCAFFOLDS FOR SEQUENCE MANIPULATION; U.S. application 62/098,059, 30 Dec. 14, RNA-TARGETING SYSTEM; U.S. application 62/096,656, 24 Dec. 14, CRISPR HAVING OR ASSOCIATED WITH DESTABILIZATION DOMAINS; U.S. application 62/096,697, 24 Dec. 14, CRISPR HAVING OR ASSOCIATED WITH AAV; U.S. application 62/098,158, 30 Dec. 14, ENGINEERED CRISPR COMPLEX INSERTIONAL TARGETING SYSTEMS; U.S. application 62/151,052, 22 Apr. 15, CELLULAR TARGETING FOR EXTRACELLULAR EXOSOMAL REPORTING; U.S. application 62/054,490, 24 Sep. 14, DELIVERY, USE AND THERAPEUTIC APPLICATIONS OF THE CRISPR-CAS SYSTEMS AND COMPOSITIONS FOR TARGETING DISORDERS AND DISEASES USING PARTICLE DELIVERY COMPONENTS; U.S. application 62/055,484, 25 Sep. 14, SYSTEMS, METHODS AND COMPOSITIONS FOR SEQUENCE MANIPULATION WITH OPTIMIZED FUNCTIONAL CRISPR-CAS SYSTEMS; U.S. application 62/087,537, 4 Dec. 14, SYSTEMS, METHODS AND COMPOSITIONS FOR SEQUENCE MANIPULATION WITH OPTIMIZED FUNCTIONAL CRISPR-CAS SYSTEMS; U.S. application 62/054,651, 24 Sep. 14, DELIVERY, USE AND THERAPEUTIC APPLICATIONS OF THE CRISPR-CAS SYSTEMS AND COMPOSITIONS FOR MODELING COMPETITION OF MULTIPLE CANCER MUTATIONS IN VIVO; U.S. application 62/067,886, 23 Oct. 14, DELIVERY, USE AND THERAPEUTIC APPLICATIONS OF THE CRISPR-CAS SYSTEMS AND COMPOSITIONS FOR MODELING COMPETITION OF MULTIPLE CANCER MUTATIONS IN VIVO; U.S. application 62/054,675, 24 Sep. 14, DELIVERY, USE AND THERAPEUTIC APPLICATIONS OF THE CRISPR-CAS SYSTEMS AND COMPOSITIONS IN NEURONAL CELLS/TISSUES; U.S. application 62/054,528, 24 Sep. 14, DELIVERY, USE AND THERAPEUTIC APPLICATIONS OF THE CRISPR-CAS SYSTEMS AND COMPOSITIONS IN IMMUNE DISEASES OR DISORDERS; U.S. application 62/055,454, 25 Sep. 14, DELIVERY, USE AND THERAPEUTIC APPLICATIONS OF THE CRISPR-CAS SYSTEMS AND COMPOSITIONS FOR TARGETING DISORDERS AND DISEASES USING CELL PENETRATION PEPTIDES (CPP); U.S. application 62/055,460, 25 Sep. 14, MULTIFUNCTIONAL-CRISPR COMPLEXES AND/OR OPTIMIZED ENZYME LINKED FUNCTIONAL-CRISPR COMPLEXES; U.S. application 62/087,475, 4 Dec. 14, FUNCTIONAL SCREENING WITH OPTIMIZED FUNCTIONAL CRISPR-CAS SYSTEMS; U.S. application 62/055,487, 25 Sep. 14, FUNCTIONAL SCREENING WITH OPTIMIZED FUNCTIONAL CRISPR-CAS SYSTEMS; U.S. application 62/087,546, 4 Dec. 14, MULTIFUNCTIONAL CRISPR COMPLEXES AND/OR OPTIMIZED ENZYME LINKED FUNCTIONAL-CRISPR COMPLEXES; and U.S. application 62/098,285, 30 Dec. 14, CRISPR MEDIATED IN VIVO MODELING AND GENETIC SCREENING OF TUMOR GROWTH AND METASTASIS.

Each of these patents, patent publications, and applications, and all documents cited therein or during their prosecution (“appin cited documents”) and all documents cited or referenced in the appin cited documents, together with any instructions, descriptions, product specifications, and product sheets for any products mentioned therein or in any document therein and incorporated by reference herein, are hereby incorporated herein by reference, and may be employed in the practice of the invention. All documents (e.g., these patents, patent publications and applications and the appin cited documents) are incorporated herein by reference to the same extent as if each individual document was specifically and individually indicated to be incorporated by reference.

Also with respect to general information on CRISPR-Cas Systems, mention is made of the following (also hereby incorporated herein by reference):

Multiplex genome engineering using CRISPR/Cas systems. Cong, L., Ran, F. A., Cox, D., Lin, S., Barretto, R., Habib, N., Hsu, P. D., Wu, X., Jiang, W., Marraffini, L. A., & Zhang, F. Science February 15; 339(6121):819-23 (2013);

RNA-guided editing of bacterial genomes using CRISPR-Cas systems. Jiang W., Bikard D., Cox D., Zhang F, Marraffini L A. Nat Biotechnol Mar; 31(3):233-9 (2013);

One-Step Generation of Mice Carrying Mutations in Multiple Genes by CRISPR/Cas-Mediated Genome Engineering. Wang H., Yang H., Shivalila C S., Dawlaty M M., Cheng A W., Zhang F., Jaenisch R. Cell May 9; 153(4):910-8 (2013);

Optical control of mammalian endogenous transcription and epigenetic states. Konermann S, Brigham M D, Trevino A E, Hsu P D, Heidenreich M, Cong L, Platt R J, Scott D A, Church G M, Zhang F. Nature. August 22; 500(7463):472-6. doi: 10.1038/Nature12466. Epub 2013 August 23 (2013);

Double Nicking by RNA-Guided CRISPR Cas9 for Enhanced Genome Editing Specificity. Ran, F A., Hsu, P D., Lin, C Y., Gootenberg, J S., Konermann, S., Trevino, A E., Scott, D A., Inoue, A., Matoba, S., Zhang, Y., & Zhang, F. Cell August 28. pii: S0092-8674(13)01015-5 (2013-A);

DNA targeting specificity of RNA-guided Cas9 nucleases. Hsu, P., Scott, D., Weinstein, J., Ran, F A., Konermann, S., Agarwala, V., Li, Y., Fine, E., Wu, X., Shalem, O., Cradick, T J., Marraffini, L A., Bao, G., & Zhang, F. Nat Biotechnol doi:10.1038/nbt.2647 (2013);

Genome engineering using the CRISPR-Cas9 system. Ran, F A., Hsu, P D., Wright, J., Agarwala, V., Scott, D A., Zhang, F. Nature Protocols Nov;8(11):2281-308 (2013-B);

Genome-Scale CRISPR-Cas9 Knockout Screening in Human Cells. Shalem, O., Sanjana, N E., Hartenian, E., Shi, X., Scott, D A., Mikkelson, T., Heckl, D., Ebert, B L., Root, D E., Doench, J G., Zhang, F. Science December 12. (2013). [Epub ahead of print];

Crystal structure of cas9 in complex with guide RNA and target DNA. Nishimasu, H., Ran, F A., Hsu, P D., Konermann, S., Shehata, S I., Dohmae, N., Ishitani, R., Zhang, F., Nureki, O. Cell Feb 27, 156(5):935-49 (2014);

Genome-wide binding of the CRISPR endonuclease Cas9 in mammalian cells. Wu X., Scott D A., Kriz A J., Chiu A C., Hsu P D., Dadon D B., Cheng A W., Trevino A E., Konermann S., Chen S., Jaenisch R., Zhang F., Sharp P A. Nat Biotechnol. April 20. doi: 10.1038/nbt.2889 (2014);

CRISPR-Cas9 Knockin Mice for Genome Editing and Cancer Modeling. Platt R J, Chen S, Zhou Y, Yim M J, Swiech L, Kempton H R, Dahlman J E, Parnas O, Eisenhaure T M, Jovanovic M, Graham D B, Jhunjhunwala S, Heidenreich M, Xavier R J, Langer R, Anderson D G, Hacohen N, Regev A, Feng G, Sharp P A, Zhang F. Cell 159(2): 440-455 DOI: 10.1016/j.ce11.2014.09.014(2014);

Development and Applications of CRISPR-Cas9 for Genome Engineering, Hsu P D, Lander E S, Zhang F., Cell. June 5; 157(6):1262-78 (2014).

Genetic screens in human cells using the CRISPR/Cas9 system, Wang T, Wei J J, Sabatini D M, Lander E S., Science. January 3; 343(6166): 80-84. doi:10.1126/science.1246981 (2014);

Rational design of highly active sgRNAs for CRISPR-Cas9-mediated gene inactivation, Doench J G, Hartenian E, Graham D B, Tothova Z, Hegde M, Smith I, Sullender M, Ebert B L, Xavier R J, Root D E., (published online Sep. 3, 2014) Nat Biotechnol. Dec; 32(12):1262-7 (2014);

In vivo interrogation of gene function in the mammalian brain using CRISPR-Cas9, Swiech L, Heidenreich M, Banerjee A, Habib N, Li Y, Trombetta J, Sur M, Zhang F., (published online 19 Oct. 2014) Nat Biotechnol. January ;33(1):102-6 (2015);

Genome-scale transcriptional activation by an engineered CRISPR-Cas9 complex, Konermann S, Brigham M D, Trevino A E, Joung J, Abudayyeh O O, Barcena C, Hsu P D, Habib N, Gootenberg J S, Nishimasu H, Nureki O, Zhang F., Nature. January 29; 517(7536):583-8 (2015).

A split-Cas9 architecture for inducible genome editing and transcription modulation, Zetsche B, Volz S E, Zhang F., (published online Feb. 2, 2015) Nat Biotechnol. Feb; 33(2):139-42 (2015);

Genome-wide CRISPR Screen in a Mouse Model of Tumor Growth and Metastasis, Chen S, Sanjana N E, Zheng K, Shalem O, Lee K, Shi X, Scott D A, Song J, Pan J Q, Weissleder R, Lee H, Zhang F, Sharp P A. Cell 160, 1246-1260, Mar. 12, 2015 (multiplex screen in mouse), and

In vivo genome editing using Staphylococcus aureus Cas9, Ran F A, Cong L, Yan W X, Scott D A, Gootenberg J S, Kriz A J, Zetsche B, Shalem O, Wu X, Makarova K S, Koonin E V, Sharp P A, Zhang F., (published online Apr. 1, 2015), Nature. April 9; 520(7546):186-91 (2015).

Shalem et al., “High-throughput functional genomics using CRISPR-Cas9,” Nature Reviews Genetics 16, 299-311 (May 2015).

Xu et al., “Sequence determinants of improved CRISPR sgRNA design,” Genome Research 25, 1147-1157 (August 2015).

Parnas et al., “A Genome-wide CRISPR Screen in Primary Immune Cells to Dissect Regulatory Networks,” Cell 162, 675-686 (Jul. 30, 2015).

Ramanan et al., CRISPR/Cas9 cleavage of viral DNA efficiently suppresses hepatitis B virus,” Scientific Reports 5:10833. doi: 10.1038/srep10833 (Jun. 2, 2015)

Nishimasu et al., Crystal Structure of Staphylococcus aureus Cas9,” Cell 162, 1113-1126 (Aug. 27, 2015)

Zetsche et al., “Cpf1 Is a Single RNA-Guided Endonuclease of a Class 2 CRISPR-Cas System,” Cell 163, 1-13 (Oct. 22, 2015)

Shmakov et al., “Discovery and Functional Characterization of Diverse Class 2 CRISPR-Cas Systems,” Molecular Cell 60, 1-13 (Available online Oct. 22, 2015)

each of which is incorporated herein by reference, may be considered in the practice of the instant invention, and discussed briefly below:

Cong et al. engineered type II CRISPR-Cas systems for use in eukaryotic cells based on both Streptococcus thermophilus Cas9 and also Streptococcus pyogenes Cas9 and demonstrated that Cas9 nucleases can be directed by short RNAs to induce precise cleavage of DNA in human and mouse cells. Their study further showed that Cas9 as converted into a nicking enzyme can be used to facilitate homology-directed repair in eukaryotic cells with minimal mutagenic activity. Additionally, their study demonstrated that multiple guide sequences can be encoded into a single CRISPR array to enable simultaneous editing of several at endogenous genomic loci sites within the mammalian genome, demonstrating easy programmability and wide applicability of the RNA-guided nuclease technology. This ability to use RNA to program sequence specific DNA cleavage in cells defined a new class of genome engineering tools. These studies further showed that other CRISPR loci are likely to be transplantable into mammalian cells and can also mediate mammalian genome cleavage. Importantly, it can be envisaged that several aspects of the CRISPR-Cas system can be further improved to increase its efficiency and versatility.

Jiang et al. used the clustered, regularly interspaced, short palindromic repeats (CRISPR)-associated Cas9 endonuclease complexed with dual-RNAs to introduce precise mutations in the genomes of Streptococcus pneumoniae and Escherichia coli. The approach relied on dual-RNA: Cas9-directed cleavage at the targeted genomic site to kill unmutated cells and circumvents the need for selectable markers or counter-selection systems. The study reported reprogramming dual-RNA: Cas9 specificity by changing the sequence of short CRISPR RNA (crRNA) to make single- and multinucleotide changes carried on editing templates. The study showed that simultaneous use of two crRNAs enabled multiplex mutagenesis. Furthermore, when the approach was used in combination with recombineering, in S. pneumoniae, nearly 100% of cells that were recovered using the described approach contained the desired mutation, and in E. coli, 65% that were recovered contained the mutation.

Wang et al. (2013) used the CRISPR/Cas system for the one-step generation of mice carrying mutations in multiple genes which were traditionally generated in multiple steps by sequential recombination in embryonic stem cells and/or time-consuming intercrossing of mice with a single mutation. The CRISPR/Cas system will greatly accelerate the in vivo study of functionally redundant genes and of epistatic gene interactions.

Konermann et al. (2013) addressed the need in the art for versatile and robust technologies that enable optical and chemical modulation of DNA-binding domains based CRISPR Cas9 enzyme and also Transcriptional Activator Like Effectors

Ran et al. (2013-A) described an approach that combined a Cas9 nickase mutant with paired guide RNAs to introduce targeted double-strand breaks. This addresses the issue of the Cas9 nuclease from the microbial CRISPR-Cas system being targeted to specific genomic loci by a guide sequence, which can tolerate certain mismatches to the DNA target and thereby promote undesired off-target mutagenesis. Because individual nicks in the genome are repaired with high fidelity, simultaneous nicking via appropriately offset guide RNAs is required for double-stranded breaks and extends the number of specifically recognized bases for target cleavage. The authors demonstrated that using paired nicking can reduce off-target activity by 50- to 1,500-fold in cell lines and to facilitate gene knockout in mouse zygotes without sacrificing on-target cleavage efficiency. This versatile strategy enables a wide variety of genome editing applications that require high specificity.

Hsu et al. (2013) characterized SpCas9 targeting specificity in human cells to inform the selection of target sites and avoid off-target effects. The study evaluated >700 guide RNA variants and SpCas9-induced indel mutation levels at >100 predicted genomic off-target loci in 293T and 293FT cells. The authors that SpCas9 tolerates mismatches between guide RNA and target DNA at different positions in a sequence-dependent manner, sensitive to the number, position and distribution of mismatches. The authors further showed that SpCas9-mediated cleavage is unaffected by DNA methylation and that the dosage of SpCas9 and sgRNA can be titrated to minimize off-target modification. Additionally, to facilitate mammalian genome engineering applications, the authors reported providing a web-based software tool to guide the selection and validation of target sequences as well as off-target analyses.

Ran et al. (2013-B) described a set of tools for Cas9-mediated genome editing via non-homologous end joining (NHEJ) or homology-directed repair (HDR) in mammalian cells, as well as generation of modified cell lines for downstream functional studies. To minimize off-target cleavage, the authors further described a double-nicking strategy using the Cas9 nickase mutant with paired guide RNAs. The protocol provided by the authors experimentally derived guidelines for the selection of target sites, evaluation of cleavage efficiency and analysis of off-target activity. The studies showed that beginning with target design, gene modifications can be achieved within as little as 1-2 weeks, and modified clonal cell lines can be derived within 2-3 weeks.

Shalem et al. described a new way to interrogate gene function on a genome-wide scale. Their studies showed that delivery of a genome-scale CRISPR-Cas9 knockout (GeCKO) library targeted 18,080 genes with 64,751 unique guide sequences enabled both negative and positive selection screening in human cells. First, the authors showed use of the GeCKO library to identify genes essential for cell viability in cancer and pluripotent stem cells. Next, in a melanoma model, the authors screened for genes whose loss is involved in resistance to vemurafenib, a therapeutic that inhibits mutant protein kinase BRAF. Their studies showed that the highest-ranking candidates included previously validated genes NF1 and MED12 as well as novel hits NF2, CUL3, TADA2B, and TADA1. The authors observed a high level of consistency between independent guide RNAs targeting the same gene and a high rate of hit confirmation, and thus demonstrated the promise of genome-scale screening with Cas9.

Nishimasu et al. reported the crystal structure of Streptococcus pyogenes Cas9 in complex with sgRNA and its target DNA at 2.5 A° resolution. The structure revealed a bilobed architecture composed of target recognition and nuclease lobes, accommodating the sgRNA: DNA heteroduplex in a positively charged groove at their interface. Whereas the recognition lobe is essential for binding sgRNA and DNA, the nuclease lobe contains the HNH and RuvC nuclease domains, which are properly positioned for cleavage of the complementary and non-complementary strands of the target DNA, respectively. The nuclease lobe also contains a carboxyl-terminal domain responsible for the interaction with the protospacer adjacent motif (PAM). This high-resolution structure and accompanying functional analyses have revealed the molecular mechanism of RNA-guided DNA targeting by Cas9, thus paving the way for the rational design of new, versatile genome-editing technologies.

Wu et al. mapped genome-wide binding sites of a catalytically inactive Cas9 (dCas9) from Streptococcus pyogenes loaded with single guide RNAs (sgRNAs) in mouse embryonic stem cells (mESCs). The authors showed that each of the four sgRNAs tested targets dCas9 to between tens and thousands of genomic sites, frequently characterized by a 5-nucleotide seed region in the sgRNA and an NGG protospacer adjacent motif (PAM). Chromatin inaccessibility decreases dCas9 binding to other sites with matching seed sequences; thus 70% of off-target sites are associated with genes. The authors showed that targeted sequencing of 295 dCas9 binding sites in mESCs transfected with catalytically active Cas9 identified only one site mutated above background levels. The authors proposed a two-state model for Cas9 binding and cleavage, in which a seed match triggers binding but extensive pairing with target DNA is required for cleavage.

Platt et al. established a Cre-dependent Cas9 knockin mouse. The authors demonstrated in vivo as well as ex vivo genome editing using adeno-associated virus (AAV)-, lentivirus-, or particle-mediated delivery of guide RNA in neurons, immune cells, and endothelial cells.

Hsu et al. (2014) is a review article that discusses generally CRISPR-Cas9 history from yogurt to genome editing, including genetic screening of cells.

Wang et al. (2014) relates to a pooled, loss-of-function genetic screening approach suitable for both positive and negative selection that uses a genome-scale lentiviral single guide RNA (sgRNA) library.

Doench et al. created a pool of sgRNAs, tiling across all possible target sites of a panel of six endogenous mouse and three endogenous human genes and quantitatively assessed their ability to produce null alleles of their target gene by antibody staining and flow cytometry. The authors showed that optimization of the PAM improved activity and also provided an on-line tool for designing sgRNAs.

Swiech et al. demonstrate that AAV-mediated SpCas9 genome editing can enable reverse genetic studies of gene function in the brain.

Konermann et al. (2015) discusses the ability to attach multiple effector domains, e.g., transcriptional activator, functional and epigenomic regulators at appropriate positions on the guide such as stem or tetraloop with and without linkers.

Zetsche et al. demonstrates that the Cas9 enzyme can be split into two and hence the assembly of Cas9 for activation can be controlled.

Chen et al. relates to multiplex screening by demonstrating that a genome-wide in vivo CRISPR-Cas9 screen in mice reveals genes regulating lung metastasis.

Ran et al. (2015) relates to SaCas9 and its ability to edit genomes and demonstrates that one cannot extrapolate from biochemical assays. Shalem et al. (2015) described ways in which catalytically inactive Cas9 (dCas9) fusions are used to synthetically repress (CRISPRi) or activate (CRISPRa) expression, showing. advances using Cas9 for genome-scale screens, including arrayed and pooled screens, knockout approaches that inactivate genomic loci and strategies that modulate transcriptional activity.

Shalem et al. (2015) described ways in which catalytically inactive Cas9 (dCas9) fusions are used to synthetically repress (CRISPRi) or activate (CRISPRa) expression, showing. advances using Cas9 for genome-scale screens, including arrayed and pooled screens, knockout approaches that inactivate genomic loci and strategies that modulate transcriptional activity.

Xu et al. (2015) assessed the DNA sequence features that contribute to single guide RNA (sgRNA) efficiency in CRISPR-based screens. The authors explored efficiency of CRISPR/Cas9 knockout and nucleotide preference at the cleavage site. The authors also found that the sequence preference for CRISPRi/a is substantially different from that for CRISPR/Cas9 knockout.

Parnas et al. (2015) introduced genome-wide pooled CRISPR-Cas9 libraries into dendritic cells (DCs) to identify genes that control the induction of tumor necrosis factor (Tnf) by bacterial lipopolysaccharide (LPS). Known regulators of Tlr4 signaling and previously unknown candidates were identified and classified into three functional modules with distinct effects on the canonical responses to LPS.

Ramanan et al (2015) demonstrated cleavage of viral episomal DNA (cccDNA) in infected cells. The HBV genome exists in the nuclei of infected hepatocytes as a 3.2 kb double-stranded episomal DNA species called covalently closed circular DNA (cccDNA), which is a key component in the HBV life cycle whose replication is not inhibited by current therapies. The authors showed that sgRNAs specifically targeting highly conserved regions of HBV robustly suppresses viral replication and depleted cccDNA.

Nishimasu et al. (2015) reported the crystal structures of SaCas9 in complex with a single guide RNA (sgRNA) and its double-stranded DNA targets, containing the 5′-TTGAAT-3′ PAM and the 5′-TTGGGT-3′ PAM. A structural comparison of SaCas9 with SpCas9 highlighted both structural conservation and divergence, explaining their distinct PAM specificities and orthologous sgRNA recognition.

Zetsche et al. (2015) reported the characterization of Cpf1, a putative class 2 CRISPR effector. It was demonstrated that Cpf1 mediates robust DNA interference with features distinct from Cas9. Identifying this mechanism of interference broadens our understanding of CRISPR-Cas systems and advances their genome editing applications.

Shmakov et al. (2015) reported the characterization of three distinct Class 2 CRISPR-Cas systems. The effectors of two of the identified systems, C2c1 and C2c3, contain RuvC like endonuclease domains distantly related to Cpf1. The third system, C2c2, contains an effector with two predicted HEPN RNase domains.

Also, “Dimeric CRISPR RNA-guided FokI nucleases for highly specific genome editing”, Shengdar Q. Tsai, Nicolas Wyvekens, Cyd Khayter, Jennifer A. Foden, Vishal Thapar, Deepak Reyon, Mathew J. Goodwin, Martin J. Aryee, J. Keith Joung Nature Biotechnology 32(6): 569-77 (2014), relates to dimeric RNA-guided FokI Nucleases that recognize extended sequences and can edit endogenous genes with high efficiencies in human cells.

In addition, mention is made of PCT application PCT/US14/70057, entitiled “DELIVERY, USE AND THERAPEUTIC APPLICATIONS OF THE CRISPR-CAS SYSTEMS AND COMPOSITIONS FOR TARGETING DISORDERS AND DISEASES USING PARTICLE DELIVERY COMPONENTS (claiming priority from one or more or all of U.S. provisional patent applications: 62/054,490, filed Sep. 24, 2014; 62/010,441, filed Jun. 10, 2014; and 61/915,118, 61/915,215 and 61/915,148, each filed on Dec. 12, 2013) (“the Particle Delivery PCT”), incorporated herein by reference, with respect to a method of preparing an sgRNA-and-Cas9 protein containing particle comprising admixing a mixture comprising an sgRNA and Cas9 protein (and optionally HDR template) with a mixture comprising or consisting essentially of or consisting of surfactant, phospholipid, biodegradable polymer, lipoprotein and alcohol; and particles from such a process. For example, wherein Cas9 protein and sgRNA were mixed together at a suitable, e.g., 3:1 to 1:3 or 2:1 to 1:2 or 1:1 molar ratio, at a suitable temperature, e.g., 15-30 C, e.g., 20-25 C, e.g., room temperature, for a suitable time, e.g., 15-45, such as 30 minutes, advantageously in sterile, nuclease free buffer, e.g., 1× PBS. Separately, particle components such as or comprising: a surfactant, e.g., cationic lipid, e.g., 1,2-dioleoyl-3-trimethylammonium-propane (DOTAP); phospholipid, e.g., dimyristoylphosphatidylcholine (DMPC); biodegradable polymer, such as an ethylene-glycol polymer or PEG, and a lipoprotein, such as a low-density lipoprotein, e.g., cholesterol were dissolved in an alcohol, advantageously a C1-6 alkyl alcohol, such as methanol, ethanol, isopropanol, e.g., 100% ethanol. The two solutions were mixed together to form particles containing the Cas9-sgRNA complexes. Accordingly, sgRNA may be pre-complexed with the Cas9 protein, before formulating the entire complex in a particle. Formulations may be made with a different molar ratio of different components known to promote delivery of nucleic acids into cells (e.g. 1,2-dioleoyl-3-trimethylammonium-propane (DOTAP), 1,2-ditetradecanoyl-sn-glycero-3-phosphocholine (DMPC), polyethylene glycol (PEG), and cholesterol) For example DOTAP:DMPC:PEG:Cholesterol Molar Ratios may be DOTAP 100, DMPC 0, PEG 0, Cholesterol 0; or DOTAP 90, DMPC 0, PEG 10, Cholesterol 0; or DOTAP 90, DMPC 0, PEG 5, Cholesterol 5. DOTAP 100, DMPC 0, PEG 0, Cholesterol 0. That application accordingly comprehends admixing sgRNA, Cas9 protein and components that form a particle; as well as particles from such admixing. Aspects of the instant invention can involve particles; for example, particles using a process analogous to that of the Particle Delivery PCT, e.g., by admixing a mixture comprising sgRNA and/or Cas9 as in the instant invention and components that form a particle, e.g., as in the Particle Delivery PCT, to form a particle and particles from such admixing (or, of course, other particles involving sgRNA and/or Cas9 as in the instant invention).

In general, the CRISPR-Cas or CRISPR system is as used in the foregoing documents, such as WO 2014/093622 (PCT/US2013/074667) and refers collectively to transcripts and other elements involved in the expression of or directing the activity of CRISPR-associated (“Cas”) genes, including sequences encoding a Cas gene, a tracr (trans-activating CRISPR) sequence (e.g. tracrRNA or an active partial tracrRNA), a tracr-mate sequence (encompassing a “direct repeat” and a tracrRNA-processed partial direct repeat in the context of an endogenous CRISPR system), a guide sequence (also referred to as a “spacer” in the context of an endogenous CRISPR system), or “RNA(s)” as that term is herein used (e.g., RNA(s) to guide Cas, such as Cas9, e.g. CRISPR RNA and transactivating (tracr) RNA or a single guide RNA (sgRNA) (chimeric RNA)) or other sequences and transcripts from a CRISPR locus. In general, a CRISPR system is characterized by elements that promote the formation of a CRISPR complex at the site of a target sequence (also referred to as a protospacer in the context of an endogenous CRISPR system). In the context of formation of a CRISPR complex, “target sequence” refers to a sequence to which a guide sequence is designed to have complementarity, where hybridization between a target sequence and a guide sequence promotes the formation of a CRISPR complex. A target sequence may comprise any polynucleotide, such as DNA or RNA polynucleotides. In some embodiments, a target sequence is located in the nucleus or cytoplasm of a cell. In some embodiments, direct repeats may be identified in silico by searching for repetitive motifs that fulfill any or all of the following criteria: 1. found in a 2 Kb window of genomic sequence flanking the type II CRISPR locus; 2. span from 20 to 50 bp; and 3. interspaced by 20 to 50 bp. In some embodiments, 2 of these criteria may be used, for instance 1 and 2, 2 and 3, or 1 and 3. In some embodiments, all 3 criteria may be used.

In embodiments of the invention the terms guide sequence and guide RNA, i.e. RNA capable of guiding Cas to a target genomic locus, are used interchangeably as in foregoing cited documents such as WO 2014/093622 (PCT/US2013/074667). In general, a guide sequence is any polynucleotide sequence having sufficient complementarity with a target polynucleotide sequence to hybridize with the target sequence and direct sequence-specific binding of a CRISPR complex to the target sequence. In some embodiments, the degree of complementarity between a guide sequence and its corresponding target sequence, when optimally aligned using a suitable alignment algorithm, is about or more than about 50%, 60%, 75%, 80%, 85%, 90%, 95%, 97.5%, 99%, or more. Optimal alignment may be determined with the use of any suitable algorithm for aligning sequences, non-limiting example of which include the Smith-Waterman algorithm, the Needleman-Wunsch algorithm, algorithms based on the Burrows-Wheeler Transform (e.g. the Burrows Wheeler Aligner), ClustalW, Clustal X, BLAT, Novoalign (Novocraft Technologies; available at www.novocraft.com), ELAND (Illumina, San Diego, Calif.), SOAP (available at soap.genomics.org.cn), and Maq (available at maq.sourceforge.net). In some embodiments, a guide sequence is about or more than about 5, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 35, 40, 45, 50, 75, or more nucleotides in length. In some embodiments, a guide sequence is less than about 75, 50, 45, 40, 35, 30, 25, 20, 15, 12, or fewer nucleotides in length. Preferably the guide sequence is 10 30 nucleotides long. The ability of a guide sequence to direct sequence-specific binding of a CRISPR complex to a target sequence may be assessed by any suitable assay. For example, the components of a CRISPR system sufficient to form a CRISPR complex, including the guide sequence to be tested, may be provided to a host cell having the corresponding target sequence, such as by transfection with vectors encoding the components of the CRISPR sequence, followed by an assessment of preferential cleavage within the target sequence, such as by Surveyor assay as described herein. Similarly, cleavage of a target polynucleotide sequence may be evaluated in a test tube by providing the target sequence, components of a CRISPR complex, including the guide sequence to be tested and a control guide sequence different from the test guide sequence, and comparing binding or rate of cleavage at the target sequence between the test and control guide sequence reactions. Other assays are possible, and will occur to those skilled in the art.

In a classic CRISPR-Cas systems, the degree of complementarity between a guide sequence and its corresponding target sequence can be about or more than about 50%, 60%, 75%, 80%, 85%, 90%, 95%, 97.5%, 99%, or 100%; a guide or RNA or sgRNA can be about or more than about 5, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 35, 40, 45, 50, 75, or more nucleotides in length; or guide or RNA or sgRNA can be less than about 75, 50, 45, 40, 35, 30, 25, 20, 15, 12, or fewer nucleotides in length; and advantageously tracr RNA is 30 or 50 nucleotides in length. However, an aspect of the invention is to reduce off-target interactions, e.g., reduce the guide interacting with a target sequence having low complementarity. Indeed, in the examples, it is shown that the invention involves mutations that result in the CRISPR-Cas system being able to distinguish between target and off-target sequences that have greater than 80% to about 95% complementarity, e.g., 83%-84% or 88-89% or 94-95% complementarity (for instance, distinguishing between a target having 18 nucleotides from an off-target of 18 nucleotides having 1, 2 or 3 mismatches). Accordingly, in the context of the present invention the degree of complementarity between a guide sequence and its corresponding target sequence is greater than 94.5% or 95% or 95.5% or 96% or 96.5% or 97% or 97.5% or 98% or 98.5% or 99% or 99.5% or 99.9%, or 100%. Off target is less than 100% or 99.9% or 99.5% or 99% or 99% or 98.5% or 98% or 97.5% or 97% or 96.5% or 96% or 95.5% or 95% or 94.5% or 94% or 93% or 92% or 91% or 90% or 89% or 88% or 87% or 86% or 85% or 84% or 83% or 82% or 81% or 80% complementarity between the sequence and the guide, with it advantageous that off target is 100% or 99.9% or 99.5% or 99% or 99% or 98.5% or 98% or 97.5% or 97% or 96.5% or 96% or 95.5% or 95% or 94.5% complementarity between the sequence and the guide.

In particularly preferred embodiments according to the invention, the guide RNA (capable of guiding Cas to a target locus) may comprise (1) a guide sequence capable of hybridizing to a genomic target locus in the eukaryotic cell; (2) a tracr sequence; and (3) a tracr mate sequence. All (1) to (3) may reside in a single RNA, i.e. an sgRNA (arranged in a 5′ to 3′ orientation), or the tracr RNA may be a different RNA than the RNA containing the guide and tracr sequence. The tracr hybridizes to the tracr mate sequence and directs the CRISPR/Cas complex to the target sequence.

The methods according to the invention as described herein comprehend inducing one or more mutations in a eukaryotic cell (in vitro, i.e. in an isolated eukaryotic cell) as herein discussed comprising delivering to cell a vector as herein discussed. The mutation(s) can include the introduction, deletion, or substitution of one or more nucleotides at each target sequence of cell(s) via the guide(s) RNA(s) or sgRNA(s). The mutations can include the introduction, deletion, or substitution of 1-75 nucleotides at each target sequence of said cell(s) via the guide(s) RNA(s) or sgRNA(s). The mutations can include the introduction, deletion, or substitution of 1, 5, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 35, 40, 45, 50, or 75 nucleotides at each target sequence of said cell(s) via the guide(s) RNA(s) or sgRNA(s). The mutations can include the introduction, deletion, or substitution of 5, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 35, 40, 45, 50, or 75 nucleotides at each target sequence of said cell(s) via the guide(s) RNA(s) or sgRNA(s). The mutations include the introduction, deletion, or substitution of 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 35, 40, 45, 50, or 75 nucleotides at each target sequence of said cell(s) via the guide(s) RNA(s) or sgRNA(s). The mutations can include the introduction, deletion, or substitution of 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 35, 40, 45, 50, or 75 nucleotides at each target sequence of said cell(s) via the guide(s) RNA(s) or sgRNA(s). The mutations can include the introduction, deletion, or substitution of 40, 45, 50, 75, 100, 200, 300, 400 or 500 nucleotides at each target sequence of said cell(s) via the guide(s) RNA(s) or sgRNA(s).

For minimization of toxicity and off-target effect, it will be important to control the concentration of Cas mRNA and guide RNA delivered. Optimal concentrations of Cas mRNA and guide RNA can be determined by testing different concentrations in a cellular or non-human eukaryote animal model and using deep sequencing the analyze the extent of modification at potential off-target genomic loci. Alternatively, to minimize the level of toxicity and off-target effect, Cas nickase mRNA (for example S. pyogenes Cas9 with the D10A mutation) can be delivered with a pair of guide RNAs targeting a site of interest. Guide sequences and strategies to minimize toxicity and off-target effects can be as in WO 2014/093622 (PCT/US2013/074667); or, via mutation as herein.

Typically, in the context of an endogenous CRISPR system, formation of a CRISPR complex (comprising a guide sequence hybridized to a target sequence and complexed with one or more Cas proteins) results in cleavage of one or both strands in or near (e.g. within 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 20, 50, or more base pairs from) the target sequence. Without wishing to be bound by theory, the tracr sequence, which may comprise or consist of all or a portion of a wild-type tracr sequence (e.g. about or more than about 20, 26, 32, 45, 48, 54, 63, 67, 85, or more nucleotides of a wild-type tracr sequence), may also form part of a CRISPR complex, such as by hybridization along at least a portion of the tracr sequence to all or a portion of a tracr mate sequence that is operably linked to the guide sequence.

The nucleic acid molecule encoding a Cas is advantageously codon optimized Cas. An example of a codon optimized sequence, is in this instance a sequence optimized for expression in a eukaryote, e.g., humans (i.e. being optimized for expression in humans), or for another eukaryote, animal or mammal as herein discussed; see, e.g., SaCas9 human codon optimized sequence in WO 2014/093622 (PCT/US2013/074667). Whilst this is preferred, it will be appreciated that other examples are possible and codon optimization for a host species other than human, or for codon optimization for specific organs is known. In some embodiments, an enzyme coding sequence encoding a Cas is codon optimized for expression in particular cells, such as eukaryotic cells. The eukaryotic cells may be those of or derived from a particular organism, such as a mammal, including but not limited to human, or non-human eukaryote or animal or mammal as herein discussed, e.g., mouse, rat, rabbit, dog, livestock, or non-human mammal or primate. In some embodiments, processes for modifying the germ line genetic identity of human beings and/or processes for modifying the genetic identity of animals which are likely to cause them suffering without any substantial medical benefit to man or animal, and also animals resulting from such processes, may be excluded. In general, codon optimization refers to a process of modifying a nucleic acid sequence for enhanced expression in the host cells of interest by replacing at least one codon (e.g. about or more than about 1, 2, 3, 4, 5, 10, 15, 20, 25, 50, or more codons) of the native sequence with codons that are more frequently or most frequently used in the genes of that host cell while maintaining the native amino acid sequence. Various species exhibit particular bias for certain codons of a particular amino acid. Codon bias (differences in codon usage between organisms) often correlates with the efficiency of translation of messenger RNA (mRNA), which is in turn believed to be dependent on, among other things, the properties of the codons being translated and the availability of particular transfer RNA (tRNA) molecules. The predominance of selected tRNAs in a cell is generally a reflection of the codons used most frequently in peptide synthesis. Accordingly, genes can be tailored for optimal gene expression in a given organism based on codon optimization. Codon usage tables are readily available, for example, at the “Codon Usage Database” available at www.kazusa.orjp/codon/ and these tables can be adapted in a number of ways. See Nakamura, Y., et al. “Codon usage tabulated from the international DNA sequence databases: status for the year 2000” Nucl. Acids Res. 28:292 (2000). Computer algorithms for codon optimizing a particular sequence for expression in a particular host cell are also available, such as Gene Forge (Aptagen; Jacobus, Pa.), are also available. In some embodiments, one or more codons (e.g. 1, 2, 3, 4, 5, 10, 15, 20, 25, 50, or more, or all codons) in a sequence encoding a Cas correspond to the most frequently used codon for a particular amino acid.

In certain embodiments, the methods as described herein may comprise providing a Cas transgenic cell in which one or more nucleic acids encoding one or more guide RNAs are provided or introduced operably connected in the cell with a regulatory element comprising a promoter of one or more gene of interest. As used herein, the term “Cas transgenic cell” refers to a cell, such as a eukaryotic cell, in which a Cas gene has been genomically integrated. The nature, type, or origin of the cell are not particularly limiting according to the present invention. Also the way how the Cas transgene is introduced in the cell is may vary and can be any method as is known in the art. In certain embodiments, the Cas transgenic cell is obtained by introducing the Cas transgene in an isolated cell. In certain other embodiments, the Cas transgenic cell is obtained by isolating cells from a Cas transgenic organism. By means of example, and without limitation, the Cas transgenic cell as referred to herein may be derived from a Cas transgenic eukaryote, such as a Cas knock-in eukaryote. Reference is made to WO 2014/093622 (PCT/US 13/74667), incorporated herein by reference. Methods of US Patent Publication Nos. 20120017290 and 20110265198 assigned to Sangamo BioSciences, Inc. directed to targeting the Rosa locus may be modified to utilize the CRISPR Cas system of the present invention. Methods of US Patent Publication No. 20130236946 assigned to Cellectis directed to targeting the Rosa locus may also be modified to utilize the CRISPR Cas system of the present invention. By means of further example reference is made to Platt et. al. (Cell; 159(2):440-455 (2014)), describing a Cas9 knock-in mouse, which is incorporated herein by reference. The Cas transgene can further comprise a Lox-Stop-polyA-Lox(LSL) cassette thereby rendering Cas expression inducible by Cre recombinase. Alternatively, the Cas transgenic cell may be obtained by introducing the Cas transgene in an isolated cell. Delivery systems for transgenes are well known in the art. By means of example, the Cas transgene may be delivered in for instance eukaryotic cell by means of vector (e.g., AAV, adenovirus, lentivirus) and/or particle and/or nanoparticle delivery, as also described herein elsewhere.

It will be understood by the skilled person that the cell, such as the Cas transgenic cell, as referred to herein may comprise further genomic alterations besides having an integrated Cas gene or the mutations arising from the sequence specific action of Cas when complexed with RNA capable of guiding Cas to a target locus, such as for instance one or more oncogenic mutations, as for instance and without limitation described in Platt et al. (2014), Chen et al., (2014) or Kumar et al. (2009).

In some embodiments, the Cas sequence is fused to one or more nuclear localization sequences (NLSs), such as about or more than about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or more NLSs. In some embodiments, the Cas comprises about or more than about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or more NLSs at or near the amino-terminus, about or more than about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or more NLSs at or near the carboxy-terminus, or a combination of these (e.g. zero or at least one or more NLS at the amino-terminus and zero or at one or more NLS at the carboxy terminus). When more than one NLS is present, each may be selected independently of the others, such that a single NLS may be present in more than one copy and/or in combination with one or more other NLSs present in one or more copies. In a preferred embodiment of the invention, the Cas comprises at most 6 NLSs. In some embodiments, an NLS is considered near the N- or C-terminus when the nearest amino acid of the NLS is within about 1, 2, 3, 4, 5, 10, 15, 20, 25, 30, 40, 50, or more amino acids along the polypeptide chain from the N- or C-terminus. Non-limiting examples of NLSs include an NLS sequence derived from: the NLS of the SV40 virus large T-antigen, having the amino acid sequence PKKKRKV(SEQ ID NO: 1); the NLS from nucleoplasmin (e.g. the nucleoplasmin bipartite NLS with the sequence KRPAATKKAGQAKKKK) (SEQ ID NO: 2); the c-myc NLS having the amino acid sequence PAAKRVKLD (SEQ ID NO: 3) or RQRRNELKRSP(SEQ ID NO: 4); the hRNPA1 M9 NLS having the sequence NQSSNFGPMKGGNFGGRSSGPYGGGGQYFAKPRNQGGY(SEQ ID NO: 5); the sequence RMRIZFKNKGKDTAELRRRRVEVSVELRKAKKDEQILKRRNV (SEQ ID NO: 6) of the IBB domain from importin-alpha; the sequences VSRKRPRP (SEQ ID NO: 7) and PPKKARED (SEQ ID NO: 8) of the myoma T protein; the sequence PQPKKKPL (SEQ ID NO: 9) of human p53; the sequence SALIKKKKKMAP (SEQ ID NO: 10) of mouse c-abl IV; the sequences DRLRR (SEQ ID NO: 11) and PKQKKRK (SEQ ID NO: 12) of the influenza virus NS1; the sequence RKLKKKIKKL (SEQ ID NO: 13) of the Hepatitis virus delta antigen; the sequence REKKKFLKRR (SEQ ID NO: 14) of the mouse Mxl protein; the sequence KRKGDEVDGVDEVAKKKSKK (SEQ ID NO: 15) of the human poly(ADP-ribose) polymerase; and the sequence RKCLQAGMNLEARKTKK (SEQ ID NO: 16) of the steroid hormone receptors (human) glucocorticoid. In general, the one or more NLSs are of sufficient strength to drive accumulation of the Cas in a detectable amount in the nucleus of a eukaryotic cell. In general, strength of nuclear localization activity may derive from the number of NLSs in the Cas, the particular NLS(s) used, or a combination of these factors. Detection of accumulation in the nucleus may be performed by any suitable technique. For example, a detectable marker may be fused to the Cas, such that location within a cell may be visualized, such as in combination with a means for detecting the location of the nucleus (e.g. a stain specific for the nucleus such as DAPI). Cell nuclei may also be isolated from cells, the contents of which may then be analyzed by any suitable process for detecting protein, such as immunohistochemistry, Western blot, or enzyme activity assay. Accumulation in the nucleus may also be determined indirectly, such as by an assay for the effect of CRISPR complex formation (e.g. assay for DNA cleavage or mutation at the target sequence, or assay for altered gene expression activity affected by CRISPR complex formation and/or Cas enzyme activity), as compared to a control no exposed to the Cas or complex, or exposed to a Cas lacking the one or more NLSs.

In certain aspects the invention involves vectors, e.g. for delivering or introducing in a cell the DNA targeting agent according to the invention as described herein, such as by means of example Cas and/or RNA capable of guiding Cas to a target locus (i.e. guide RNA), but also for propagating these components (e.g. in prokaryotic cells). A used herein, a “vector” is a tool that allows or facilitates the transfer of an entity from one environment to another. It is a replicon, such as a plasmid, phage, or cosmid, into which another DNA segment may be inserted so as to bring about the replication of the inserted segment. Generally, a vector is capable of replication when associated with the proper control elements. In general, the term “vector” refers to a nucleic acid molecule capable of transporting another nucleic acid to which it has been linked. Vectors include, but are not limited to, nucleic acid molecules that are single-stranded, double-stranded, or partially double-stranded; nucleic acid molecules that comprise one or more free ends, no free ends (e.g. circular); nucleic acid molecules that comprise DNA, RNA, or both; and other varieties of polynucleotides known in the art. One type of vector is a “plasmid,” which refers to a circular double stranded DNA loop into which additional DNA segments can be inserted, such as by standard molecular cloning techniques. Another type of vector is a viral vector, wherein virally-derived DNA or RNA sequences are present in the vector for packaging into a virus (e.g. retroviruses, replication defective retroviruses, adenoviruses, replication defective adenoviruses, and adeno-associated viruses (AAVs)). Viral vectors also include polynucleotides carried by a virus for transfection into a host cell. Certain vectors are capable of autonomous replication in a host cell into which they are introduced (e.g. bacterial vectors having a bacterial origin of replication and episomal mammalian vectors). Other vectors (e.g., non-episomal mammalian vectors) are integrated into the genome of a host cell upon introduction into the host cell, and thereby are replicated along with the host genome. Moreover, certain vectors are capable of directing the expression of genes to which they are operatively-linked. Such vectors are referred to herein as “expression vectors.” Common expression vectors of utility in recombinant DNA techniques are often in the form of plasmids.

Recombinant expression vectors can comprise a nucleic acid of the invention in a form suitable for expression of the nucleic acid in a host cell, which means that the recombinant expression vectors include one or more regulatory elements, which may be selected on the basis of the host cells to be used for expression, that is operatively-linked to the nucleic acid sequence to be expressed. Within a recombinant expression vector, “operably linked” is intended to mean that the nucleotide sequence of interest is linked to the regulatory element(s) in a manner that allows for expression of the nucleotide sequence (e.g. in an in vitro transcription/translation system or in a host cell when the vector is introduced into the host cell). With regards to recombination and cloning methods, mention is made of U.S. patent application Ser. No. 10/815,730, published Sep. 2, 2004 as US 2004-0171156 A1, the contents of which are herein incorporated by reference in their entirety.

The vector(s) can include the regulatory element(s), e.g., promoter(s). The vector(s) can comprise Cas encoding sequences, and/or a single, but possibly also can comprise at least 3 or 8 or 16 or 32 or 48 or 50 guide RNA(s) (e.g., sgRNAs) encoding sequences, such as 1-2, 1-3, 1-4 1-5, 3-6, 3-7, 3-8, 3-9, 3-10, 3-8, 3-16, 3-30, 3-32, 3-48, 3-50 RNA(s) (e.g., sgRNAs). In a single vector there can be a promoter for each RNA (e.g., sgRNA), advantageously when there are up to about 16 RNA(s) (e.g., sgRNAs); and, when a single vector provides for more than 16 RNA(s) (e.g., sgRNAs), one or more promoter(s) can drive expression of more than one of the RNA(s) (e.g., sgRNAs), e.g., when there are 32 RNA(s) (e.g., sgRNAs), each promoter can drive expression of two RNA(s) (e.g., sgRNAs), and when there are 48 RNA(s) (e.g., sgRNAs), each promoter can drive expression of three RNA(s) (e.g., sgRNAs). By simple arithmetic and well established cloning protocols and the teachings in this disclosure one skilled in the art can readily practice the invention as to the RNA(s) (e.g., sgRNA(s) for a suitable exemplary vector such as AAV, and a suitable promoter such as the U6 promoter, e.g., U6-sgRNAs. For example, the packaging limit of AAV is ˜4.7 kb. The length of a single U6-sgRNA (plus restriction sites for cloning) is 361 bp. Therefore, the skilled person can readily fit about 12-16, e.g., 13 U6-sgRNA cassettes in a single vector. This can be assembled by any suitable means, such as a golden gate strategy used for TALE assembly (http://www.genome-engineering.org/taleffectors/). The skilled person can also use a tandem guide strategy to increase the number of U6-sgRNAs by approximately 1.5 times, e.g., to increase from 12-16, e.g., 13 to approximately 18-24, e.g., about 19 U6-sgRNAs. Therefore, one skilled in the art can readily reach approximately 18-24, e.g., about 19 promoter-RNAs, e.g., U6-sgRNAs in a single vector, e.g., an AAV vector. A further means for increasing the number of promoters and RNAs, e.g., sgRNA(s) in a vector is to use a single promoter (e.g., U6) to express an array of RNAs, e.g., sgRNAs separated by cleavable sequences. And an even further means for increasing the number of promoter-RNAs, e.g., sgRNAs in a vector, is to express an array of promoter-RNAs, e.g., sgRNAs separated by cleavable sequences in the intron of a coding sequence or gene; and, in this instance it is advantageous to use a polymerase II promoter, which can have increased expression and enable the transcription of long RNA in a tissue specific manner. (see, e.g., http://nar.oxfordjournals.org/content/34/7/e53.short, http://www.nature.com/mt/journal/v16/n9/ab s/mt2008144 a.html). In an advantageous embodiment, AAV may package U6 tandem sgRNA targeting up to about 50 genes. Accordingly, from the knowledge in the art and the teachings in this disclosure the skilled person can readily make and use vector(s), e.g., a single vector, expressing multiple RNAs or guides or sgRNAs under the control or operatively or functionally linked to one or more promoters-especially as to the numbers of RNAs or guides or sgRNAs discussed herein, without any undue experimentation.

A poly nucleic acid sequence encoding the DNA targeting agent according to the invention as described herein, such as by means of example guide RNA(s), e.g., sgRNA(s) encoding sequences and/or Cas encoding sequences, can be functionally or operatively linked to regulatory element(s) and hence the regulatory element(s) drive expression. The promoter(s) can be constitutive promoter(s) and/or conditional promoter(s) and/or inducible promoter(s) and/or tissue specific promoter(s). The promoter can be selected from the group consisting of RNA polymerases, pol I, pol II, pol III, T7, U6, H1, retroviral Rous sarcoma virus (RSV) LTR promoter, the cytomegalovirus (CMV) promoter, the SV40 promoter, the dihydrofolate reductase promoter, the β-actin promoter, the phosphoglycerol kinase (PGK) promoter, and the EF1α promoter. An advantageous promoter is the promoter is U6.

Through this disclosure and the knowledge in the art, the DNA targeting agent as described herein, such as, TALEs, CRISPR-Cas systems, etc., or components thereof or nucleic acid molecules thereof (including, for instance HDR template) or nucleic acid molecules encoding or providing components thereof may be delivered by a delivery system herein described both generally and in detail.

Vector delivery, e.g., plasmid, viral delivery: By means of example, the CRISPR enzyme, for instance a Cas9, and/or any of the present RNAs, for instance a guide RNA, can be delivered using any suitable vector, e.g., plasmid or viral vectors, such as adeno associated virus (AAV), lentivirus, adenovirus or other viral vector types, or combinations thereof. The DNA targeting agent as described herein, such as Cas9 and one or more guide RNAs can be packaged into one or more vectors, e.g., plasmid or viral vectors. In some embodiments, the vector, e.g., plasmid or viral vector is delivered to the tissue of interest by, for example, an intramuscular injection, while other times the delivery is via intravenous, transdermal, intranasal, oral, mucosal, or other delivery methods. Such delivery may be either via a single dose, or multiple doses. One skilled in the art understands that the actual dosage to be delivered herein may vary greatly depending upon a variety of factors, such as the vector choice, the target cell, organism, or tissue, the general condition of the subject to be treated, the degree of transformation/modification sought, the administration route, the administration mode, the type of transformation/modification sought, etc.

Such a dosage may further contain, for example, a carrier (water, saline, ethanol, glycerol, lactose, sucrose, calcium phosphate, gelatin, dextran, agar, pectin, peanut oil, sesame oil, etc.), a diluent, a pharmaceutically-acceptable carrier (e.g., phosphate-buffered saline), a pharmaceutically-acceptable excipient, and/or other compounds known in the art. The dosage may further contain one or more pharmaceutically acceptable salts such as, for example, a mineral acid salt such as a hydrochloride, a hydrobromide, a phosphate, a sulfate, etc.; and the salts of organic acids such as acetates, propionates, malonates, benzoates, etc. Additionally, auxiliary substances, such as wetting or emulsifying agents, pH buffering substances, gels or gelling materials, flavorings, colorants, microspheres, polymers, suspension agents, etc. may also be present herein. In addition, one or more other conventional pharmaceutical ingredients, such as preservatives, humectants, suspending agents, surfactants, antioxidants, anticaking agents, fillers, chelating agents, coating agents, chemical stabilizers, etc. may also be present, especially if the dosage form is a reconstitutable form. Suitable exemplary ingredients include microcrystalline cellulose, carboxymethylcellulose sodium, polysorbate 80, phenylethyl alcohol, chlorobutanol, potassium sorbate, sorbic acid, sulfur dioxide, propyl gallate, the parabens, ethyl vanillin, glycerin, phenol, parachlorophenol, gelatin, albumin and a combination thereof. A thorough discussion of pharmaceutically acceptable excipients is available in REMINGTON'S PHARMACEUTICAL SCIENCES (Mack Pub. Co., N.J. 1991) which is incorporated by reference herein.

In an embodiment herein the delivery is via an adenovirus, which may be at a single booster dose containing at least 1×10⁵ particles (also referred to as particle units, pu) of adenoviral vector. In an embodiment herein, the dose preferably is at least about 1×10⁶ particles (for example, about 1×10⁶-1×10¹² particles), more preferably at least about 1×10⁷ particles, more preferably at least about 1×10⁸ particles (e.g., about 1×10⁸-1×10¹¹ particles or about 1×10⁸-1×10¹² particles), and most preferably at least about 1×10° particles (e.g., about 1×10⁹-1×10¹⁰ particles or about 1×10⁹-1×10¹² particles), or even at least about 1×10¹⁰ particles (e.g., about 1×10¹⁰-1×10¹² particles) of the adenoviral vector. Alternatively, the dose comprises no more than about 1×10¹⁴ particles, preferably no more than about 1×10¹³ particles, even more preferably no more than about 1×10¹² particles, even more preferably no more than about 1×10¹¹ particles, and most preferably no more than about 1×10¹⁰ particles (e.g., no more than about 1×10⁹ articles). Thus, the dose may contain a single dose of adenoviral vector with, for example, about 1×10⁶ particle units (pu), about 2×10⁶ pu, about 4×10⁶ pu, about 1×10⁷ pu, about 2×10⁷ pu, about 4×10⁷ pu, about 1×10⁸ pu, about 2×10⁸ pu, about 4×10⁸ pu, about 1×10⁹ pu, about 2×10⁹ pu, about 4×10⁹ pu, about 1×10¹⁰ pu, about 2×10¹⁰ pu, about 4×10¹⁰ pu, about 1×10¹¹ pu, about 2×10¹¹ pu, about 4×10¹¹ pu, about 1×10¹² pu, about 2×10¹² pu, or about 4×10¹² pu of adenoviral vector. See, for example, the adenoviral vectors in U.S. Pat. No. 8,454,972 B2 to Nabel, et. al., granted on Jun. 4, 2013; incorporated by reference herein, and the dosages at col 29, lines 36-58 thereof. In an embodiment herein, the adenovirus is delivered via multiple doses.

In an embodiment herein, the delivery is via an AAV. A therapeutically effective dosage for in vivo delivery of the AAV to a human is believed to be in the range of from about 20 to about 50 ml of saline solution containing from about 1×10¹⁰ to about 1×10¹⁰ functional AAV/ml solution. The dosage may be adjusted to balance the therapeutic benefit against any side effects. In an embodiment herein, the AAV dose is generally in the range of concentrations of from about 1×10⁵ to 1×10⁵⁰ genomes AAV, from about 1×10⁸ to 1×10²⁰ genomes AAV, from about 1×10¹⁰ to about 1×10¹⁶ genomes, or about 1×10¹¹ to about 1×10¹⁶ genomes AAV. A human dosage may be about 1×10¹³ genomes AAV. Such concentrations may be delivered in from about 0.001 ml to about 100 ml, about 0.05 to about 50 ml, or about 10 to about 25 ml of a carrier solution. Other effective dosages can be readily established by one of ordinary skill in the art through routine trials establishing dose response curves. See, for example, U.S. Pat. No. 8,404,658 B2 to Hajjar, et al., granted on Mar. 26, 2013, at col. 27, lines 45-60.

In an embodiment herein the delivery is via a plasmid. In such plasmid compositions, the dosage should be a sufficient amount of plasmid to elicit a response. For instance, suitable quantities of plasmid DNA in plasmid compositions can be from about 0.1 to about 2 mg, or from about 1 μg to about 10 μg per 70 kg individual. Plasmids of the invention will generally comprise (i) a promoter; (ii) a sequence encoding a DNA targeting agent as described herein, such as a comprising a CRISPR enzyme, operably linked to said promoter; (iii) a selectable marker; (iv) an origin of replication; and (v) a transcription terminator downstream of and operably linked to (ii). The plasmid can also encode the RNA components of a CRISPR complex, but one or more of these may instead be encoded on a different vector.

The doses herein are based on an average 70 kg individual. The frequency of administration is within the ambit of the medical or veterinary practitioner (e.g., physician, veterinarian), or scientist skilled in the art. It is also noted that mice used in experiments are typically about 20 g and from mice experiments one can scale up to a 70 kg individual.

In some embodiments the RNA molecules of the invention are delivered in liposome or lipofectin formulations and the like and can be prepared by methods well known to those skilled in the art. Such methods are described, for example, in U.S. Pat. Nos. 5,593,972, 5,589,466, and 5,580,859, which are herein incorporated by reference. Delivery systems aimed specifically at the enhanced and improved delivery of siRNA into mammalian cells have been developed, (see, for example, Shen et al FEBS Let. 2003, 539:111-114; Xia et al., Nat. Biotech. 2002, 20:1006-1010; Reich et al., Mol. Vision. 2003, 9: 210-216; Sorensen et al., J. Mol. Biol. 2003, 327: 761-766; Lewis et al., Nat. Gen. 2002, 32: 107-108 and Simeoni et al., NAR 2003, 31, 11: 2717-2724) and may be applied to the present invention. siRNA has recently been successfully used for inhibition of gene expression in primates (see for example. Tolentino et al., Retina 24(4):660 which may also be applied to the present invention.

Indeed, RNA delivery is a useful method of in vivo delivery. It is possible to deliver the DNA targeting agent as described herein, such as Cas9 and gRNA (and, for instance, HR repair template) into cells using liposomes or particles. Thus delivery of the CRISPR enzyme, such as a Cas9 and/or delivery of the RNAs of the invention may be in RNA form and via microvesicles, liposomes or particles. For example, Cas9 mRNA and gRNA can be packaged into liposomal particles for delivery in vivo. Liposomal transfection reagents such as lipofectamine from Life Technologies and other reagents on the market can effectively deliver RNA molecules into the liver.

Means of delivery of RNA also preferred include delivery of RNA via nanoparticles (Cho, S., Goldberg, M., Son, S., Xu, Q., Yang, F., Mei, Y., Bogatyrev, S., Langer, R. and Anderson, D., Lipid-like nanoparticles for small interfering RNA delivery to endothelial cells, Advanced Functional Materials, 19: 3112-3118, 2010) or exosomes (Schroeder, A., Levins, C., Cortez, C., Langer, R., and Anderson, D., Lipid-based nanotherapeutics for siRNA delivery, Journal of Internal Medicine, 267: 9-21, 2010, PMID: 20059641). Indeed, exosomes have been shown to be particularly useful in delivery siRNA, a system with some parallels to the CRISPR system. For instance, El-Andaloussi S, et al. (“Exosome-mediated delivery of siRNA in vitro and in vivo.” Nat Protoc. 2012 December; 7(12):2112-26. doi: 10.1038/nprot.2012.131. Epub 2012 Nov. 15.) describe how exosomes are promising tools for drug delivery across different biological barriers and can be harnessed for delivery of siRNA in vitro and in vivo. Their approach is to generate targeted exosomes through transfection of an expression vector, comprising an exosomal protein fused with a peptide ligand. The exosomes are then purify and characterized from transfected cell supernatant, then RNA is loaded into the exosomes. Delivery or administration according to the invention can be performed with exosomes, in particular but not limited to the brain. Vitamin E (α-tocopherol) may be conjugated with CRISPR Cas and delivered to the brain along with high density lipoprotein (HDL), for example in a similar manner as was done by Uno et al. (HUMAN GENE THERAPY 22:711-719 (June 2011)) for delivering short-interfering RNA (siRNA) to the brain. Mice were infused via Osmotic minipumps (model 1007D; Alzet, Cupertino, Calif.) filled with phosphate-buffered saline (PBS) or free TocsiBACE or Toc-siBACE/HDL and connected with Brain Infusion Kit 3 (Alzet). A brain-infusion cannula was placed about 0.5 mm posterior to the bregma at midline for infusion into the dorsal third ventricle. Uno et al. found that as little as 3 nmol of Toc-siRNA with HDL could induce a target reduction in comparable degree by the same ICV infusion method. A similar dosage of CRISPR Cas conjugated to a-tocopherol and co-administered with HDL targeted to the brain may be contemplated for humans in the present invention, for example, about 3 nmol to about 3 μmol of CRISPR Cas targeted to the brain may be contemplated. Zou et al. ((HUMAN GENE THERAPY 22:465-475 (April 2011)) describes a method of lentiviral-mediated delivery of short-hairpin RNAs targeting PKCγ for in vivo gene silencing in the spinal cord of rats. Zou et al. administered about 10 μl of a recombinant lentivirus having a titer of 1×10⁹ transducing units (TU)/ml by an intrathecal catheter. A similar dosage of CRISPR Cas expressed in a lentiviral vector targeted to the brain may be contemplated for humans in the present invention, for example, about 10-50 ml of CRISPR Cas targeted to the brain in a lentivirus having a titer of 1×10⁹ transducing units (TU)/ml may be contemplated.

In terms of local delivery to the brain, this can be achieved in various ways. For instance, material can be delivered intrastriatally e.g. by injection. Injection can be performed stereotactically via a craniotomy.

Enhancing NHEJ or HR efficiency is also helpful for delivery. It is preferred that NHEJ efficiency is enhanced by co-expressing end-processing enzymes such as Trex2 (Dumitrache et al. Genetics. 2011 August; 188(4): 787-797). It is preferred that HR efficiency is increased by transiently inhibiting NHEJ machineries such as Ku70 and Ku86. HR efficiency can also be increased by co-expressing prokaryotic or eukaryotic homologous recombination enzymes such as RecBCD, RecA.

Packaging and Promoters Generally

Ways to package nucleic acid molecules, in particular the DNA targeting agent according to the invention as described herein, such as Cas9 coding nucleic acid molecules, e.g., DNA, into vectors, e.g., viral vectors, to mediate genome modification in vivo include:

To Achieve NHEJ-Mediated Gene Knockout:

Single Virus Vector:

Vector containing two or more expression cassettes:

Promoter-Cas9 coding nucleic acid molecule-terminator

Promoter-gRNA 1-terminator

Promoter-gRNA2-terminator

Promoter-gRNA(N)-terminator (up to size limit of vector)

Double Virus Vector:

Vector 1 containing one expression cassette for driving the expression of Cas9

Promoter-Cas9 coding nucleic acid molecule-terminator

Vector 2 containing one more expression cassettes for driving the expression of one or more guideRNAs

Promoter-gRNA 1-terminator

Promoter-gRNA(N)-terminator (up to size limit of vector)

To Mediate Homology-Directed Repair.

In addition to the single and double virus vector approaches described above, an additional vector is used to deliver a homology-direct repair template.

The promoter used to drive Cas9 coding nucleic acid molecule expression can include:

AAV ITR can serve as a promoter: this is advantageous for eliminating the need for an additional promoter element (which can take up space in the vector). The additional space freed up can be used to drive the expression of additional elements (gRNA, etc.). Also, ITR activity is relatively weaker, so can be used to reduce potential toxicity due to over expression of Cas9.

For ubiquitous expression, can use promoters: CMV, CAG, CBh, PGK, SV40, Ferritin heavy or light chains, etc.

For brain or other CNS expression, can use promoters: SynapsinI for all neurons, CaMKIIalpha for excitatory neurons, GAD67 or GAD65 or VGAT for GABAergic neurons, etc.

For liver expression, can use Albumin promoter.

For lung expression, can use SP-B.

For endothelial cells, can use ICAM.

For hematopoietic cells can use IFNbeta or CD45.

For Osteoblasts can use OG-2.

The promoter used to drive guide RNA can include:

Pol III promoters such as U6 or H1

Use of Pol II promoter and intronic cassettes to express gRNA

Adeno Associated Virus (AAV)

The DNA targeting agent according to the invention as described herein, such as by means of example Cas9 and one or more guide RNA can be delivered using adeno associated virus (AAV), lentivirus, adenovirus or other plasmid or viral vector types, in particular, using formulations and doses from, for example, U.S. Pat. No. 8,454,972 (formulations, doses for adenovirus), U.S. Pat. No. 8,404,658 (formulations, doses for AAV) and U.S. Pat. No. 5,846,946 (formulations, doses for DNA plasmids) and from clinical trials and publications regarding the clinical trials involving lentivirus, AAV and adenovirus. For examples, for AAV, the route of administration, formulation and dose can be as in U.S. Pat. No. 8,454,972 and as in clinical trials involving AAV. For Adenovirus, the route of administration, formulation and dose can be as in U.S. Pat. No. 8,404,658 and as in clinical trials involving adenovirus. For plasmid delivery, the route of administration, formulation and dose can be as in U.S. Pat. No 5,846,946 and as in clinical studies involving plasmids. Doses may be based on or extrapolated to an average 70 kg individual (e.g. a male adult human), and can be adjusted for patients, subjects, mammals of different weight and species. Frequency of administration is within the ambit of the medical or veterinary practitioner (e.g., physician, veterinarian), depending on usual factors including the age, sex, general health, other conditions of the patient or subject and the particular condition or symptoms being addressed. The viral vectors can be injected into the tissue of interest. For cell-type specific genome modification, the expression of the DNA targeting agent according to the invention as described herein, such as by means of example Cas9 can be driven by a cell-type specific promoter. For example, liver-specific expression might use the Albumin promoter and neuron-specific expression (e.g. for targeting CNS disorders) might use the Synapsin I promoter.

In terms of in vivo delivery, AAV is advantageous over other viral vectors for a couple of reasons:

• • Low toxicity (this may be due to the purification method not requiring ultra centrifugation of cell particles that can activate the immune response)
  • Low probability of causing insertional mutagenesis because it doesn't integrate into the host genome.

AAV has a packaging limit of 4.5 or 4.75 Kb. This means that for instance Cas9 as well as a promoter and transcription terminator have to be all fit into the same viral vector. Constructs larger than 4.5 or 4.75 Kb will lead to significantly reduced virus production. SpCas9 is quite large, the gene itself is over 4.1 Kb, which makes it difficult for packing into AAV. Therefore embodiments of the invention include utilizing homologs of Cas9 that are shorter. For example:

Species                          Cas9 Size

Corynebacter diphtheriae         3252
Eubacterium ventriosum           3321
Streptococcus pasteurianus       3390
Lactobacillus farciminis         3378
Sphaerochaeta globus             3537
Azospirillum B510                3504
Gluconacetobacter diazotrophicus 3150
Neisseria cinerea                3246
Roseburia intestinalis           3420
Parvibaculum lavamentivorans     3111
Staphylococcus aureus            3159
Nitratifractor salsuginis DSM 16511 3396
Campylobacter lari CF89-12       3009
Streptococcus thermophilus LMD-9 3396

These species are therefore, in general, preferred Cas9 species.

As to AAV, the AAV can be AAV1, AAV2, AAV5 or any combination thereof. One can select the AAV of the AAV with regard to the cells to be targeted; e.g., one can select AAV serotypes 1, 2, 5 or a hybrid capsid AAV1, AAV2, AAV5 or any combination thereof for targeting brain or neuronal cells; and one can select AAV4 for targeting cardiac tissue. AAV8 is useful for delivery to the liver. The herein promoters and vectors are preferred individually. A tabulation of certain AAV serotypes as to these cells (see Grimm, D. et al, J. Virol. 82: 5887-5911 (2008)) is as follows:

Cell Line	AAV-1	AAV-2	AAV-3	AAV-4	AAV-5	AAV-6	AAV-8	AAV-9
Huh-7	13	100	2.5	0.0	0.1	10	0.7	0.0
HEK293	25	100	2.5	0.1	0.1	5	0.7	0.1
HeLa	3	100	2.0	0.1	6.7	1	0.2	0.1
HepG2	3	100	16.7	0.3	1.7	5	0.3	ND
Hep1A	20	100	0.2	1.0	0.1	1	0.2	0.0
911	17	100	11	0.2	0.1	17	0.1	ND
CHO	100	100	14	1.4	333	50	10	1.0
COS	33	100	33	3.3	5.0	14	2.0	0.5
MeWo	10	100	20	0.3	6.7	10	1.0	0.2
NIH3T3	10	100	2.9	2.9	0.3	10	0.3	ND
A549	14	100	20	ND	0.5	10	0.5	0.1
HT1180	20	100	10	0.1	0.3	33	0.5	0.1
Monocytes	1111	100	ND	ND	125	1429	ND	ND
Immature DC	2500	100	ND	ND	222	2857	ND	ND
Mature DC	2222	100	ND	ND	333	3333	ND	ND

Lentivirus

Lentiviruses are complex retroviruses that have the ability to infect and express their genes in both mitotic and post-mitotic cells. The most commonly known lentivirus is the human immunodeficiency virus (HIV), which uses the envelope glycoproteins of other viruses to target a broad range of cell types.

Lentiviruses may be prepared as follows, by means of example for Cas delivery. After cloning pCasES 10 (which contains a lentiviral transfer plasmid backbone), HEK293FT at low passage (p=5) were seeded in a T-75 flask to 50% confluence the day before transfection in DMEM with 10% fetal bovine serum and without antibiotics. After 20 hours, media was changed to OptiMEM (serum-free) media and transfection was done 4 hours later. Cells were transfected with 10 μg of lentiviral transfer plasmid (pCasES10) and the following packaging plasmids: 5 μg of pMD2.G (VSV-g pseudotype), and 7.5 ug of psPAX2 (gag/pol/rev/tat). Transfection was done in 4 mL OptiMEM with a cationic lipid delivery agent (50 uL Lipofectamine 2000 and 100 ul Plus reagent). After 6 hours, the media was changed to antibiotic-free DMEM with 10% fetal bovine serum. These methods use serum during cell culture, but serum-free methods are preferred.

Lentivirus may be purified as follows. Viral supernatants were harvested after 48 hours. Supernatants were first cleared of debris and filtered through a 0.45 um low protein binding (PVDF) filter. They were then spun in a ultracentrifuge for 2 hours at 24,000 rpm. Viral pellets were resuspended in 50 ul of DMEM overnight at 4 C. They were then aliquotted and immediately frozen at −80° C.

In another embodiment, minimal non-primate lentiviral vectors based on the equine infectious anemia virus (EIAV) are also contemplated, especially for ocular gene therapy (see, e.g., Balagaan, J Gene Med 2006; 8: 275-285). In another embodiment, RetinoStat®, an equine infectious anemia virus-based lentiviral gene therapy vector that expresses angiostatic proteins endostatin and angiostatin that is delivered via a subretinal injection for the treatment of the web form of age-related macular degeneration is also contemplated (see, e.g., Binley et al., HUMAN GENE THERAPY 23:980-991 (September 2012)) and this vector may be modified for the CRISPR-Cas system of the present invention.

In another embodiment, self-inactivating lentiviral vectors with an siRNA targeting a common exon shared by HIV tat/rev, a nucleolar-localizing TAR decoy, and an anti-CCR5-specific hammerhead ribozyme (see, e.g., DiGiusto et al. (2010) Sci Transl Med 2:36ra43) may be used/and or adapted to the CRISPR-Cas system of the present invention. A minimum of 2.5×10⁶ CD34+ cells per kilogram patient weight may be collected and prestimulated for 16 to 20 hours in X-VIVO 15 medium (Lonza) containing 2 μmol/L-glutamine, stem cell factor (100 ng/ml), Flt-3 ligand (Flt-3L) (100 ng/ml), and thrombopoietin (10 ng/ml) (CellGenix) at a density of 2×10⁶ cells/ml. Prestimulated cells may be transduced with lentiviral at a multiplicity of infection of 5 for 16 to 24 hours in 75-cm² tissue culture flasks coated with fibronectin (25 mg/cm²) (RetroNectin,Takara Bio Inc.).

Lentiviral vectors have been disclosed as in the treatment for Parkinson's Disease, see, e.g., US Patent Publication No. 20120295960 and U.S. Pat. Nos. 7,303,910 and 7,351,585. Lentiviral vectors have also been disclosed for the treatment of ocular diseases, see e.g., US Patent Publication Nos. 20060281180, 20090007284, US20110117189; US20090017543; US20070054961, US20100317109. Lentiviral vectors have also been disclosed for delivery to the brain, see, e.g., US Patent Publication Nos. US20110293571; US20110293571, US20040013648, US20070025970, US20090111106 and U.S. Pat. No. 7,259,015.

RNA Delivery

RNA delivery: The DNA targeting agent according to the invention as described herein, such as the CRISPR enzyme, for instance a Cas9, and/or any of the present RNAs, for instance a guide RNA, can also be delivered in the form of RNA. Cas9 mRNA can be generated using in vitro transcription. For example, Cas9 mRNA can be synthesized using a PCR cassette containing the following elements: T7_promoter-kozak sequence (GCCACC)-Cas9-3′ UTR from beta globin-polyA tail (a string of 120 or more adenines). The cassette can be used for transcription by T7 polymerase. Guide RNAs can also be transcribed using in vitro transcription from a cassette containing T7_promoter-GG-guide RNA sequence.

To enhance expression and reduce possible toxicity, the CRISPR enzyme-coding sequence and/or the guide RNA can be modified to include one or more modified nucleoside e.g. using pseudo-U or 5-Methyl-C.

mRNA delivery methods are especially promising for liver delivery currently.

Much clinical work on RNA delivery has focused on RNAi or antisense, but these systems can be adapted for delivery of RNA for implementing the present invention. References below to RNAi etc. should be read accordingly.

Particle Delivery Systems and/or Formulations:

Several types of particle delivery systems and/or formulations are known to be useful in a diverse spectrum of biomedical applications. In general, a particle is defined as a small object that behaves as a whole unit with respect to its transport and properties. Particles are further classified according to diameter Coarse particles cover a range between 2,500 and 10,000 nanometers. Fine particles are sized between 100 and 2,500 nanometers. Ultrafine particles, or nanoparticles, are generally between 1 and 100 nanometers in size. The basis of the 100-nm limit is the fact that novel properties that differentiate particles from the bulk material typically develop at a critical length scale of under 100 nm.

As used herein, a particle delivery system/formulation is defined as any biological delivery system/formulation which includes a particle in accordance with the present invention. A particle in accordance with the present invention is any entity having a greatest dimension (e.g. diameter) of less than 100 microns (μm). In some embodiments, inventive particles have a greatest dimension of less than 10 μm. In some embodiments, inventive particles have a greatest dimension of less than 2000 nanometers (nm). In some embodiments, inventive particles have a greatest dimension of less than 1000 nanometers (nm). In some embodiments, inventive particles have a greatest dimension of less than 900 nm, 800 nm, 700 nm, 600 nm, 500 nm, 400 nm, 300 nm, 200 nm, or 100 nm. Typically, inventive particles have a greatest dimension (e.g., diameter) of 500 nm or less. In some embodiments, inventive particles have a greatest dimension (e.g., diameter) of 250 nm or less. In some embodiments, inventive particles have a greatest dimension (e.g., diameter) of 200 nm or less. In some embodiments, inventive particles have a greatest dimension (e.g., diameter) of 150 nm or less. In some embodiments, inventive particles have a greatest dimension (e.g., diameter) of 100 nm or less. Smaller particles, e.g., having a greatest dimension of 50 nm or less are used in some embodiments of the invention. In some embodiments, inventive particles have a greatest dimension ranging between 25 nm and 200 nm.

Particle characterization (including e.g., characterizing morphology, dimension, etc.) is done using a variety of different techniques. Common techniques are electron microscopy (TEM, SEM), atomic force microscopy (AFM), dynamic light scattering (DLS), X-ray photoelectron spectroscopy (XPS), powder X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), matrix-assisted laser desorption/ionization time-of-flight mass spectrometry(MALDI-TOF), ultraviolet-visible spectroscopy, dual polarisation interferometry and nuclear magnetic resonance (NMR). Characterization (dimension measurements) may be made as to native particles (i.e., preloading) or after loading of the cargo (herein cargo refers to e.g., one or more components of for instance CRISPR-Cas system e.g., CRISPR enzyme or mRNA or guide RNA, or any combination thereof, and may include additional carriers and/or excipients) to provide particles of an optimal size for delivery for any in vitro, ex vivo and/or in vivo application of the present invention. In certain preferred embodiments, particle dimension (e.g., diameter) characterization is based on measurements using dynamic laser scattering (DLS). Mention is made of U.S. Pat. Nos. 8,709,843; 6,007,845; 5,855,913; 5,985,309; 5,543,158; and the publication by James E. Dahlman and Carmen Barnes et al. Nature Nanotechnology (2014) published online 11 May 2014, doi:10.1038/nnano.2014.84, concerning particles, methods of making and using them and measurements thereof.

Particles delivery systems within the scope of the present invention may be provided in any form, including but not limited to solid, semi-solid, emulsion, or colloidal particles. As such any of the delivery systems described herein, including but not limited to, e.g., lipid-based systems, liposomes, micelles, microvesicles, exosomes, or gene gun may be provided as particle delivery systems within the scope of the present invention.

Particles

The DNA targeting agent according to the invention as described herein, such as by means of example CRISPR enzyme mRNA and guide RNA may be delivered simultaneously using particles or lipid envelopes; for instance, CRISPR enzyme and RNA of the invention, e.g., as a complex, can be delivered via a particle as in Dahlman et al., WO2015089419 A2 and documents cited therein, such as 7C1 (see, e.g., James E. Dahlman and Carmen Barnes et al. Nature Nanotechnology (2014) published online 11 May 2014, doi:10.1038/nnano.2014.84), e.g., delivery particle comprising lipid or lipidoid and hydrophilic polymer, e.g., cationic lipid and hydrophilic polymer, for instance wherein the the cationic lipid comprises 1,2-dioleoyl-3-trimethylammonium-propane (DOTAP) or 1,2-ditetradecanoyl-sn-glycero-3-phosphocholine (DMPC) and/or wherein the hydrophilic polymer comprises ethylene glycol or polyethylene glycol (PEG); and/or wherein the particle further comprises cholesterol (e.g., particle from formulation 1=DOTAP 100, DMPC 0, PEG 0, Cholesterol 0; formulation number 2=DOTAP 90, DMPC 0, PEG 10, Cholesterol 0; formulation number 3=DOTAP 90, DMPC 0, PEG 5, Cholesterol 5), wherein particles are formed using an efficient, multistep process wherein first, effector protein and RNA are mixed together, e.g., at a 1:1 molar ratio, e.g., at room temperature, e.g., for 30 minutes, e.g., in sterile, nuclease free 1× PBS; and separately, DOTAP, DMPC, PEG, and cholesterol as applicable for the formulation are dissolved in alcohol, e.g., 100% ethanol; and, the two solutions are mixed together to form particles containing the complexes).

For example, Su X, Fricke J, Kavanagh D G, Irvine D J (“In vitro and in vivo mRNA delivery using lipid-enveloped pH-responsive polymer nanoparticles” Mol Pharm. 2011 Jun. 6; 8(3):774-87. doi: 10.1021/mp100390w. Epub 2011 Apr. 1) describes biodegradable core-shell structured particles with a poly(β-amino ester) (PBAE) core enveloped by a phospholipid bilayer shell. These were developed for in vivo mRNA delivery. The pH-responsive PBAE component was chosen to promote endosome disruption, while the lipid surface layer was selected to minimize toxicity of the polycation core. Such are, therefore, preferred for delivering RNA of the present invention.

In one embodiment, particles based on self assembling bioadhesive polymers are contemplated, which may be applied to oral delivery of peptides, intravenous delivery of peptides and nasal delivery of peptides, all to the brain. Other embodiments, such as oral absorption and ocular delivery of hydrophobic drugs are also contemplated. The molecular envelope technology involves an engineered polymer envelope which is protected and delivered to the site of the disease (see, e.g., Mazza, M. et al. ACSNano, 2013. 7(2): 1016-1026; Siew, A., et al. Mol Pharm, 2012. 9(1):14-28; Lalatsa, A., et al. J Contr Rel, 2012. 161(2):523-36; Lalatsa, A., et al., Mol Pharm, 2012. 9(6):1665-80; Lalatsa, A., et al. Mol Pharm, 2012. 9(6):1764-74; Garrett, N. L., et al. J Biophotonics, 2012. 5(5-6):458-68; Garrett, N. L., et al. J Raman Spect, 2012. 43(5):681-688; Ahmad, S., et al. J Royal Soc Interface 2010. 7:S423-33; Uchegbu, I. F. Expert Opin Drug Deliv, 2006. 3(5):629-40; Qu, X.,et al. Biomacromolecules, 2006. 7(12):3452-9 and Uchegbu, I. F., et al. Int J Pharm, 2001. 224:185-199). Doses of about 5 mg/kg are contemplated, with single or multiple doses, depending on the target tissue.

In one embodiment, particles that can deliver DNA targeting agents according to the invention as described herein, such as RNA to a cancer cell to stop tumor growth developed by Dan Anderson's lab at MIT may be used/and or adapted to the CRISPR Cas system according to certain embodiments of the present invention. In particular, the Anderson lab developed fully automated, combinatorial systems for the synthesis, purification, characterization, and formulation of new biomaterials and nanoformulations. See, e.g., Alabi et al., Proc Natl Acad Sci USA. Aug. 6, 2013; 110(32):12881-6; Zhang et al., Adv Mater. Sep 6, 2013; 25(33):4641-5; Jiang et al., Nano Lett. Mar. 13, 2013; 13(3):1059-64; Karagiannis et al., ACS Nano. Oct. 23, 2012; 6(10):8484-7; Whitehead et al., ACS Nano. Aug. 28, 2012; 6(8):6922-9 and Lee et al., Nat Nanotechnol. 2012 Jun. 3; 7(6):389-93.

US patent application 20110293703 relates to lipidoid compounds are also particularly useful in the administration of polynucleotides, which may be applied to deliver the DNA targeting agent according to the invention, such as for instance the CRISPR Cas system according to certain embodiments of the present invention. In one aspect, the aminoalcohol lipidoid compounds are combined with an agent to be delivered to a cell or a subject to form microparticles, particles, liposomes, or micelles. The agent to be delivered by the particles, liposomes, or micelles may be in the form of a gas, liquid, or solid, and the agent may be a polynucleotide, protein, peptide, or small molecule. The minoalcohol lipidoid compounds may be combined with other aminoalcohol lipidoid compounds, polymers (synthetic or natural), surfactants, cholesterol, carbohydrates, proteins, lipids, etc. to form the particles. These particles may then optionally be combined with a pharmaceutical excipient to form a pharmaceutical composition.

US Patent Publication No. 20110293703 also provides methods of preparing the aminoalcohol lipidoid compounds. One or more equivalents of an amine are allowed to react with one or more equivalents of an epoxide-terminated compound under suitable conditions to form an aminoalcohol lipidoid compound of the present invention. In certain embodiments, all the amino groups of the amine are fully reacted with the epoxide-terminated compound to form tertiary amines. In other embodiments, all the amino groups of the amine are not fully reacted with the epoxide-terminated compound to form tertiary amines thereby resulting in primary or secondary amines in the aminoalcohol lipidoid compound. These primary or secondary amines are left as is or may be reacted with another electrophile such as a different epoxide-terminated compound. As will be appreciated by one skilled in the art, reacting an amine with less than excess of epoxide-terminated compound will result in a plurality of different aminoalcohol lipidoid compounds with various numbers of tails. Certain amines may be fully functionalized with two epoxide-derived compound tails while other molecules will not be completely functionalized with epoxide-derived compound tails. For example, a diamine or polyamine may include one, two, three, or four epoxide-derived compound tails off the various amino moieties of the molecule resulting in primary, secondary, and tertiary amines. In certain embodiments, all the amino groups are not fully functionalized. In certain embodiments, two of the same types of epoxide-terminated compounds are used. In other embodiments, two or more different epoxide-terminated compounds are used. The synthesis of the aminoalcohol lipidoid compounds is performed with or without solvent, and the synthesis may be performed at higher temperatures ranging from 30-100° C., preferably at approximately 50-90° C. The prepared aminoalcohol lipidoid compounds may be optionally purified. For example, the mixture of aminoalcohol lipidoid compounds may be purified to yield an aminoalcohol lipidoid compound with a particular number of epoxide-derived compound tails. Or the mixture may be purified to yield a particular stereo- or regioisomer. The aminoalcohol lipidoid compounds may also be alkylated using an alkyl halide (e.g., methyl iodide) or other alkylating agent, and/or they may be acylated.

US Patent Publication No. 20110293703 also provides libraries of aminoalcohol lipidoid compounds prepared by the inventive methods. These aminoalcohol lipidoid compounds may be prepared and/or screened using high-throughput techniques involving liquid handlers, robots, microtiter plates, computers, etc. In certain embodiments, the aminoalcohol lipidoid compounds are screened for their ability to transfect polynucleotides or other agents (e.g., proteins, peptides, small molecules) into the cell.

US Patent Publication No. 20130302401 relates to a class of poly(beta-amino alcohols) (PBAAs) has been prepared using combinatorial polymerization. The inventive PBAAs may be used in biotechnology and biomedical applications as coatings (such as coatings of films or multilayer films for medical devices or implants), additives, materials, excipients, non-biofouling agents, micropatterning agents, and cellular encapsulation agents. When used as surface coatings, these PBAAs elicited different levels of inflammation, both in vitro and in vivo, depending on their chemical structures. The large chemical diversity of this class of materials allowed us to identify polymer coatings that inhibit macrophage activation in vitro. Furthermore, these coatings reduce the recruitment of inflammatory cells, and reduce fibrosis, following the subcutaneous implantation of carboxylated polystyrene microparticles. These polymers may be used to form polyelectrolyte complex capsules for cell encapsulation. The invention may also have many other biological applications such as antimicrobial coatings, DNA or siRNA delivery, and stem cell tissue engineering. The teachings of US Patent Publication No. 20130302401 may be applied to the DNA targeting agent according to the invention, such as for instance the CRISPR Cas system according to certain embodiments of the present invention.

In another embodiment, lipid particles (LNPs) are contemplated. An antitransthyretin small interfering RNA has been encapsulated in lipid particles and delivered to humans (see, e.g., Coelho et al., N Engl J Med 2013; 369:819-29), and such a ssystem may be adapted and applied to the CRISPR Cas system of the present invention. Doses of about 0.01 to about 1 mg per kg of body weight administered intravenously are contemplated. Medications to reduce the risk of infusion-related reactions are contemplated, such as dexamethasone, acetampinophen, diphenhydramine or cetirizine, and ranitidine are contemplated. Multiple doses of about 0.3 mg per kilogram every 4 weeks for five doses are also contemplated.

LNPs have been shown to be highly effective in delivering siRNAs to the liver (see, e.g., Tabernero et al., Cancer Discovery, April 2013, Vol. 3, No. 4, pages 363-470) and are therefore contemplated for delivering RNA encoding CRISPR Cas to the liver. A dosage of about four doses of 6 mg/kg of the LNP every two weeks may be contemplated. Tabernero et al. demonstrated that tumor regression was observed after the first 2 cycles of LNPs dosed at 0.7 mg/kg, and by the end of 6 cycles the patient had achieved a partial response with complete regression of the lymph node metastasis and substantial shrinkage of the liver tumors. A complete response was obtained after 40 doses in this patient, who has remained in remission and completed treatment after receiving doses over 26 months. Two patients with RCC and extrahepatic sites of disease including kidney, lung, and lymph nodes that were progressing following prior therapy with VEGF pathway inhibitors had stable disease at all sites for approximately 8 to 12 months, and a patient with PNET and liver metastases continued on the extension study for 18 months (36 doses) with stable disease.

However, the charge of the LNP must be taken into consideration. As cationic lipids combined with negatively charged lipids to induce nonbilayer structures that facilitate intracellular delivery. Because charged LNPs are rapidly cleared from circulation following intravenous injection, ionizable cationic lipids with pKa values below 7 were developed (see, e.g., Rosin et al, Molecular Therapy, vol. 19, no. 12, pages 1286-2200, December 2011). Negatively charged polymers such as RNA may be loaded into LNPs at low pH values (e.g., pH 4) where the ionizable lipids display a positive charge. However, at physiological pH values, the LNPs exhibit a low surface charge compatible with longer circulation times. Four species of ionizable cationic lipids have been focused upon, namely 1,2-dilineoyl-3-dimethylammonium-propane (DLinDAP), 1,2-dilinoleyloxy-3-N,N-dimethylaminopropane (DLinDMA), 1,2-dilinoleyloxy-keto-N,N-dimethyl-3-aminopropane (DLinKDMA), and 1,2-dilinoleyl-4-(2-dimethylaminoethyl)-[1,3]-dioxolane (DLinKC2-DMA). It has been shown that LNP siRNA systems containing these lipids exhibit remarkably different gene silencing properties in hepatocytes in vivo, with potencies varying according to the series DLinKC2-DMA>DLinKDMA>DLinDMA>>DLinDAP employing a Factor VII gene silencing model (see, e.g., Rosin et al, Molecular Therapy, vol. 19, no. 12, pages 1286-2200, December 2011). A dosage of 1 μg/ml of LNP or by means of example CRISPR-Cas RNA in or associated with the LNP may be contemplated, especially for a formulation containing DLinKC2-DMA.

Preparation of LNPs and the DNA targeting agent according to the invention as described herein, such as by means of example CRISPR Cas encapsulation may be used/and or adapted from Rosin et al, Molecular Therapy, vol. 19, no. 12, pages 1286-2200, December 2011). The cationic lipids 1,2-dilineoyl-3-dimethylammonium-propane (DLinDAP), 1,2-dilinoleyloxy-3-N,N-dimethylaminopropane (DLinDMA), 1,2-dilinoleyloxyketo-N,N-dimethyl-3-aminopropane (DLinK-DMA), 1,2-dilinoleyl-4-(2-dimethylaminoethyl)-[1,3]-dioxolane (DLinKC2-DMA), (3-o-[2″-(methoxypolyethyleneglycol 2000) succinoyl]-1,2-dimyristoyl-sn-glycol (PEG-S-DMG), and R-3-[(ω-methoxy-poly(ethylene glycol)2000) carbamoyl]-1,2-dimyristyloxlpropyl-3-amine (PEG-C-DOMG) may be provided by Tekmira Pharmaceuticals (Vancouver, Canada) or synthesized. Cholesterol may be purchased from Sigma (St Louis, Mo.). The specific CRISPR Cas RNA may be encapsulated in LNPs containing DLinDAP, DLinDMA, DLinK-DMA, and DLinKC2-DMA (cationic lipid:DSPC:CHOL:PEGS-DMG or PEG-C-DOMG at 40:10:40:10 molar ratios). When required, 0.2% SP-DiOC18 (Invitrogen, Burlington, Canada) may be incorporated to assess cellular uptake, intracellular delivery, and biodistribution. Encapsulation may be performed by dissolving lipid mixtures comprised of cationic lipid:DSPC:cholesterol:PEG-c-DOMG (40:10:40:10 molar ratio) in ethanol to a final lipid concentration of 10 mmol/l. This ethanol solution of lipid may be added drop-wise to 50 mmol/l citrate, pH 4.0 to form multilamellar vesicles to produce a final concentration of 30% ethanol vol/vol. Large unilamellar vesicles may be formed following extrusion of multilamellar vesicles through two stacked 80 nm Nuclepore polycarbonate filters using the Extruder (Northern Lipids, Vancouver, Canada). Encapsulation may be achieved by adding RNA dissolved at 2 mg/ml in 50 mmol/1 citrate, pH 4.0 containing 30% ethanol vol/vol drop-wise to extruded preformed large unilamellar vesicles and incubation at 31° C. for 30 minutes with constant mixing to a final RNA/lipid weight ratio of 0.06/1 wt/wt. Removal of ethanol and neutralization of formulation buffer were performed by dialysis against phosphate-buffered saline (PBS), pH 7.4 for 16 hours using Spectra/Por 2 regenerated cellulose dialysis membranes. Particle size distribution may be determined by dynamic light scattering using a NICOMP 370 particle sizer, the vesicle/intensity modes, and Gaussian fitting (Nicomp Particle Sizing, Santa Barbara, Calif.). The particle size for all three LNP systems may be ˜70 nm in diameter. RNA encapsulation efficiency may be determined by removal of free RNA using VivaPureD MiniH columns (Sartorius Stedim Biotech) from samples collected before and after dialysis. The encapsulated RNA may be extracted from the eluted particles and quantified at 260 nm. RNA to lipid ratio was determined by measurement of cholesterol content in vesicles using the Cholesterol E enzymatic assay from Wako Chemicals USA (Richmond, Va.). In conjunction with the herein discussion of LNPs and PEG lipids, PEGylated liposomes or LNPs are likewise suitable for delivery of a CRISPR-Cas system or components thereof.

Preparation of large LNPs may be used/and or adapted from Rosin et al, Molecular Therapy, vol. 19, no. 12, pages 1286-2200, December 2011. A lipid premix solution (20.4 mg/ml total lipid concentration) may be prepared in ethanol containing DLinKC2-DMA, DSPC, and cholesterol at 50:10:38.5 molar ratios. Sodium acetate may be added to the lipid premix at a molar ratio of 0.75:1 (sodium acetate:DLinKC2-DMA). The lipids may be subsequently hydrated by combining the mixture with 1.85 volumes of citrate buffer (10 mmol/l, pH 3.0) with vigorous stirring, resulting in spontaneous liposome formation in aqueous buffer containing 35% ethanol. The liposome solution may be incubated at 37° C. to allow for time-dependent increase in particle size. Aliquots may be removed at various times during incubation to investigate changes in liposome size by dynamic light scattering (Zetasizer Nano ZS, Malvern Instruments, Worcestershire, UK). Once the desired particle size is achieved, an aqueous PEG lipid solution (stock=10 mg/ml PEG-DMG in 35% (vol/vol) ethanol) may be added to the liposome mixture to yield a final PEG molar concentration of 3.5% of total lipid. Upon addition of PEG-lipids, the liposomes should their size, effectively quenching further growth. RNA may then be added to the empty liposomes at an RNA to total lipid ratio of approximately 1:10 (wt:wt), followed by incubation for 30 minutes at 37° C. to form loaded LNPs. The mixture may be subsequently dialyzed overnight in PBS and filtered with a 0.45-μm syringe filter.

Spherical Nucleic Acid (SNA™) constructs and other particles (particularly gold particles) are also contemplated as a means to deliver the DNA targeting agent according to the invention as described herein, such as by means of example CRISPR-Cas system to intended targets. Significant data show that AuraSense Therapeutics' Spherical Nucleic Acid (SNA™) constructs, based upon nucleic acid-functionalized gold particles, are useful.

Literature that may be employed in conjunction with herein teachings include: Cutler et al., J. Am. Chem. Soc. 2011 133:9254-9257, Hao et al., Small. 2011 7:3158-3162, Zhang et al., ACS Nano. 2011 5:6962-6970, Cutler et al., J. Am. Chem. Soc. 2012 134:1376-1391, Young et al., Nano Lett. 2012 12:3867-71, Zheng et al., Proc. Natl. Acad. Sci. USA. 2012 109:11975-80, Mirkin, Nanomedicine 2012 7:635-638 Zhang et al., J. Am. Chem. Soc. 2012 134:16488-1691, Weintraub, Nature 2013 495:S14-S16, Choi et al., Proc. Natl. Acad. Sci. USA. 2013 110(19):7625-7630, Jensen et al., Sci. Transl. Med. 5, 209ra152 (2013) and Mirkin, et al., Small, 10:186-192.

Self-assembling particles with RNA may be constructed with polyethyleneimine (PEI) that is PEGylated with an Arg-Gly-Asp (RGD) peptide ligand attached at the distal end of the polyethylene glycol (PEG). This system has been used, for example, as a means to target tumor neovasculature expressing integrins and deliver siRNA inhibiting vascular endothelial growth factor receptor-2 (VEGF R2) expression and thereby achieve tumor angiogenesis (see, e.g., Schiffelers et al., Nucleic Acids Research, 2004, Vol. 32, No. 19). Nanoplexes may be prepared by mixing equal volumes of aqueous solutions of cationic polymer and nucleic acid to give a net molar excess of ionizable nitrogen (polymer) to phosphate (nucleic acid) over the range of 2 to 6. The electrostatic interactions between cationic polymers and nucleic acid resulted in the formation of polyplexes with average particle size distribution of about 100 nm, hence referred to here as nanoplexes. A dosage of about 100 to 200 mg of CRISPR Cas is envisioned for delivery in the self-assembling particles of Schiffelers et al.

The nanoplexes of Bartlett et al. (PNAS, Sep. 25, 2007,vol. 104, no. 39) may also be applied to the present invention. The nanoplexes of Bartlett et al. are prepared by mixing equal volumes of aqueous solutions of cationic polymer and nucleic acid to give a net molar excess of ionizable nitrogen (polymer) to phosphate (nucleic acid) over the range of 2 to 6. The electrostatic interactions between cationic polymers and nucleic acid resulted in the formation of polyplexes with average particle size distribution of about 100 nm, hence referred to here as nanoplexes. The DOTA-siRNA of Bartlett et al. was synthesized as follows: 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid mono(N-hydroxysuccinimide ester) (DOTA-NHSester) was ordered from Macrocyclics (Dallas, Tex.). The amine modified RNA sense strand with a 100-fold molar excess of DOTA-NHS-ester in carbonate buffer (pH 9) was added to a microcentrifuge tube. The contents were reacted by stirring for 4 h at room temperature. The DOTA-RNAsense conjugate was ethanol-precipitated, resuspended in water, and annealed to the unmodified antisense strand to yield DOTA-siRNA. All liquids were pretreated with Chelex-100 (Bio-Rad, Hercules, Calif.) to remove trace metal contaminants. Tf-targeted and nontargeted siRNA particles may be formed by using cyclodextrin-containing polycations. Typically, particles were formed in water at a charge ratio of 3 (+/−) and an siRNA concentration of 0.5 g/liter. One percent of the adamantane-PEG molecules on the surface of the targeted particles were modified with Tf (adamantane-PEG-Tf). The particles were suspended in a 5% (wt/vol) glucose carrier solution for injection.

Davis et al. (Nature, Vol 464, 15 Apr. 2010) conducts a RNA clinical trial that uses a targeted particle-delivery system (clinical trial registration number NCT00689065). Patients with solid cancers refractory to standard-of-care therapies are administered doses of targeted particles on days 1, 3, 8 and 10 of a 21-day cycle by a 30-min intravenous infusion. The particles consist of a synthetic delivery system containing: (1) a linear, cyclodextrin-based polymer (CDP), (2) a human transferrin protein (TF) targeting ligand displayed on the exterior of the particle to engage TF receptors (TFR) on the surface of the cancer cells, (3) a hydrophilic polymer (polyethylene glycol (PEG) used to promote particle stability in biological fluids), and (4) siRNA designed to reduce the expression of the RRM2 (sequence used in the clinic was previously denoted siR2B+5). The TFR has long been known to be upregulated in malignant cells, and RRM2 is an established anti-cancer target. These particles (clinical version denoted as CALAA-01) have been shown to be well tolerated in multi-dosing studies in non-human primates. Although a single patient with chronic myeloid leukaemia has been administered siRNAby liposomal delivery, Davis et al.'s clinical trial is the initial human trial to systemically deliver siRNA with a targeted delivery system and to treat patients with solid cancer. To ascertain whether the targeted delivery system can provide effective delivery of functional siRNA to human tumours, Davis et al. investigated biopsies from three patients from three different dosing cohorts; patients A, B and C, all of whom had metastatic melanoma and received CALAA-01 doses of 18, 24 and 30 mg m⁻² siRNA, respectively. Similar doses may also be contemplated for the CRISPR Cas system of the present invention. The delivery of the invention may be achieved with particles containing a linear, cyclodextrin-based polymer (CDP), a human transferrin protein (TF) targeting ligand displayed on the exterior of the particle to engage TF receptors (TFR) on the surface of the cancer cells and/or a hydrophilic polymer (for example, polyethylene glycol (PEG) used to promote particle stability in biological fluids).

In terms of this invention, it is preferred to have one or more components of the DNA targeting agent according to the invention as described herein, such as by means of example the CRISPR complex, e.g., CRISPR enzyme or mRNA or guide RNA delivered using particles or lipid envelopes. Other delivery systems or vectors are may be used in conjunction with the particle aspects of the invention.

In general, a “nanoparticle” refers to any particle having a diameter of less than 1000 nm. In certain preferred embodiments, nanoparticles of the invention have a greatest dimension (e.g., diameter) of 500 nm or less. In other preferred embodiments, nanoparticles of the invention have a greatest dimension ranging between 25 nm and 200 nm. In other preferred embodiments, nanoparticles of the invention have a greatest dimension of 100 nm or less. In other preferred embodiments, particles of the invention have a greatest dimension ranging between 35 nm and 60 nm. In other preferred embodiments, the particles of the invention are not nanoparticles.

Particles encompassed in the present invention may be provided in different forms, e.g., as solid particles (e.g., metal such as silver, gold, iron, titanium), non-metal, lipid-based solids, polymers), suspensions of particles, or combinations thereof. Metal, dielectric, and semiconductor particles may be prepared, as well as hybrid structures (e.g., core-shell particles). Particles made of semiconducting material may also be labeled quantum dots if they are small enough (typically sub 10 nm) that quantization of electronic energy levels occurs. Such nanoscale particles are used in biomedical applications as drug carriers or imaging agents and may be adapted for similar purposes in the present invention.

Semi-solid and soft particles have been manufactured, and are within the scope of the present invention. A prototype particle of semi-solid nature is the liposome. Various types of liposome particles are currently used clinically as delivery systems for anticancer drugs and vaccines. Particles with one half hydrophilic and the other half hydrophobic are termed Janus particles and are particularly effective for stabilizing emulsions. They can self-assemble at water/oil interfaces and act as solid surfactants.

U.S. Pat. No. 8,709,843, incorporated herein by reference, provides a drug delivery system for targeted delivery of therapeutic agent-containing particles to tissues, cells, and intracellular compartments. The invention provides targeted particles comprising comprising polymer conjugated to a surfactant, hydrophilic polymer or lipid. U.S. Pat. No. 6,007,845, incorporated herein by reference, provides particles which have a core of a multiblock copolymer formed by covalently linking a multifunctional compound with one or more hydrophobic polymers and one or more hydrophilic polymers, and conatin a biologically active material. U.S. Pat. No. 5,855,913, incorporated herein by reference, provides a particulate composition having aerodynamically light particles having a tap density of less than 0.4 g/cm3 with a mean diameter of between 5 μm and 30 μm, incorporating a surfactant on the surface thereof for drug delivery to the pulmonary system. U.S. Pat. No. 5,985,309, incorporated herein by reference, provides particles incorporating a surfactant and/or a hydrophilic or hydrophobic complex of a positively or negatively charged therapeutic or diagnostic agent and a charged molecule of opposite charge for delivery to the pulmonary system. U.S. Pat. No. 5,543,158, incorporated herein by reference, provides biodegradable injectable particles having a biodegradable solid core containing a biologically active material and poly(alkylene glycol) moieties on the surface. WO2012135025 (also published as US20120251560), incorporated herein by reference, describes conjugated polyethyleneimine (PEI) polymers and conjugated aza-macrocycles (collectively referred to as “conjugated lipomer” or “lipomers”). In certain embodiments, it can envisioned that such conjugated lipomers can be used in the context of the CRISPR-Cas system to achieve in vitro, ex vivo and in vivo genomic perturbations to modify gene expression, including modulation of protein expression.

In one embodiment, the particle may be epoxide-modified lipid-polymer, advantageously 7C1 (see, e.g., James E. Dahlman and Carmen Barnes et al. Nature Nanotechnology (2014) published online 11 May 2014, doi:10.1038/nnano.2014.84). C71 was synthesized by reacting C15 epoxide-terminated lipids with PEI600 at a 14:1 molar ratio, and was formulated with C14PEG2000 to produce particles (diameter between 35 and 60 nm) that were stable in PBS solution for at least 40 days.

An epoxide-modified lipid-polymer may be utilized to deliver the CRISPR-Cas system of the present invention to pulmonary, cardiovascular or renal cells, however, one of skill in the art may adapt the system to deliver to other target organs. Dosage ranging from about 0.05 to about 0.6 mg/kg are envisioned. Dosages over several days or weeks are also envisioned, with a total dosage of about 2 mg/kg.

Exosomes

Exosomes are endogenous nano-vesicles that transport RNAs and proteins, and which can deliver RNA to the brain and other target organs. To reduce immunogenicity, Alvarez-Erviti et al. (2011, Nat Biotechnol 29: 341) used self-derived dendritic cells for exosome production. Targeting to the brain was achieved by engineering the dendritic cells to express Lamp2b, an exosomal membrane protein, fused to the neuron-specific RVG peptide. Purified exosomes were loaded with exogenous RNA by electroporation. Intravenously injected RVG-targeted exosomes delivered GAPDH siRNA specifically to neurons, microglia, oligodendrocytes in the brain, resulting in a specific gene knockdown. Pre-exposure to RVG exosomes did not attenuate knockdown, and non-specific uptake in other tissues was not observed. The therapeutic potential of exosome-mediated siRNA delivery was demonstrated by the strong mRNA (60%) and protein (62%) knockdown of BACE1, a therapeutic target in Alzheimer's disease.

To obtain a pool of immunologically inert exosomes, Alvarez-Erviti et al. harvested bone marrow from inbred C57BL/6 mice with a homogenous major histocompatibility complex (MHC) haplotype. As immature dendritic cells produce large quantities of exosomes devoid of T-cell activators such as MHC-II and CD86, Alvarez-Erviti et al. selected for dendritic cells with granulocyte/macrophage-colony stimulating factor (GM-CSF) for 7 d. Exosomes were purified from the culture supernatant the following day using well-established ultracentrifugation protocols. The exosomes produced were physically homogenous, with a size distribution peaking at 80 nm in diameter as determined by particle tracking analysis (NTA) and electron microscopy. Alvarez-Erviti et al. obtained 6-12 μg of exosomes (measured based on protein concentration) per 10⁶ cells.

Next, Alvarez-Erviti et al. investigated the possibility of loading modified exosomes with exogenous cargoes using electroporation protocols adapted for nanoscale applications. As electroporation for membrane particles at the nanometer scale is not well-characterized, nonspecific Cy5-labeled RNA was used for the empirical optimization of the electroporation protocol. The amount of encapsulated RNA was assayed after ultracentrifugation and lysis of exosomes. Electroporation at 400 V and 125 μF resulted in the greatest retention of RNA and was used for all subsequent experiments.

Alvarez-Erviti et al. administered 150 μg of each BACE1 siRNA encapsulated in 150 μg of RVG exosomes to normal C57BL/6 mice and compared the knockdown efficiency to four controls: untreated mice, mice injected with RVG exosomes only, mice injected with BACE1 siRNA complexed to an in vivo cationic liposome reagent and mice injected with BACE1 siRNA complexed to RVG-9R, the RVG peptide conjugated to 9 D-arginines that electrostatically binds to the siRNA. Cortical tissue samples were analyzed 3 d after administration and a significant protein knockdown (45%, P<0.05, versus 62%, P<0.01) in both siRNA-RVG-9R-treated and siRNARVG exosome-treated mice was observed, resulting from a significant decrease in BACE1 mRNA levels (66% [+ or −] 15%, P<0.001 and 61% [+or −] 13% respectively, P<0.01). Moreover, Applicants demonstrated a significant decrease (55%, P<0.05) in the total [beta]-amyloid 1-42 levels, a main component of the amyloid plaques in Alzheimer's pathology, in the RVG-exosome-treated animals. The decrease observed was greater than the β-amyloid 1-40 decrease demonstrated in normal mice after intraventricular injection of BACE1 inhibitors. Alvarez-Erviti et al. carried out 5′-rapid amplification of cDNA ends (RACE) on BACE1 cleavage product, which provided evidence of RNAi-mediated knockdown by the siRNA.

Finally, Alvarez-Erviti et al. investigated whether RNA-RVG exosomes induced immune responses in vivo by assessing IL-6, IP-10, TNFα and IFN-α serum concentrations. Following exosome treatment, nonsignificant changes in all cytokines were registered similar to siRNA-transfection reagent treatment in contrast to siRNA-RVG-9R, which potently stimulated IL-6 secretion, confirming the immunologically inert profile of the exosome treatment. Given that exosomes encapsulate only 20% of siRNA, delivery with RVG-exosome appears to be more efficient than RVG-9R delivery as comparable mRNA knockdown and greater protein knockdown was achieved with fivefold less siRNA without the corresponding level of immune stimulation. This experiment demonstrated the therapeutic potential of RVG-exosome technology, which is potentially suited for long-term silencing of genes related to neurodegenerative diseases. The exosome delivery system of Alvarez-Erviti et al. may be applied to deliver the the DNA targeting agent according to the invention as described herein, such as by means of example the CRISPR-Cas system of the present invention to therapeutic targets, especially neurodegenerative diseases. A dosage of about 100 to 1000 mg of CRISPR Cas encapsulated in about 100 to 1000 mg of RVG exosomes may be contemplated for the present invention.

El-Andaloussi et al. (Nature Protocols 7,2112-2126(2012)) discloses how exosomes derived from cultured cells can be harnessed for delivery of RNA in vitro and in vivo. This protocol first describes the generation of targeted exosomes through transfection of an expression vector, comprising an exosomal protein fused with a peptide ligand. Next, El-Andaloussi et al. explain how to purify and characterize exosomes from transfected cell supernatant. Next, El-Andaloussi et al. detail crucial steps for loading RNA into exosomes. Finally, El-Andaloussi et al. outline how to use exosomes to efficiently deliver RNA in vitro and in vivo in mouse brain. Examples of anticipated results in which exosome-mediated RNA delivery is evaluated by functional assays and imaging are also provided. The entire protocol takes ˜3 weeks. Delivery or administration according to the invention may be performed using exosomes produced from self-derived dendritic cells. From the herein teachings, this can be employed in the practice of the invention.

In another embodiment, the plasma exosomes of Wahlgren et al. (Nucleic Acids Research, 2012, Vol. 40, No. 17 e130) are contemplated. Exosomes are nano-sized vesicles (30-90 nm in size) produced by many cell types, including dendritic cells (DC), B cells, T cells, mast cells, epithelial cells and tumor cells. These vesicles are formed by inward budding of late endosomes and are then released to the extracellular environment upon fusion with the plasma membrane. Because exosomes naturally carry RNA between cells, this property may be useful in gene therapy, and from this disclosure can be employed in the practice of the instant invention.

Exosomes from plasma can be prepared by centrifugation of buffy coat at 900 g for 20 min to isolate the plasma followed by harvesting cell supernatants, centrifuging at 300 g for 10 min to eliminate cells and at 16 500 g for 30 min followed by filtration through a 0.22 mm filter. Exosomes are pelleted by ultracentrifugation at 120 000 g for70 min. Chemical transfection of siRNA into exosomes is carried out according to the manufacturer's instructions in RNAi Human/Mouse Starter Kit (Quiagen, Hilden, Germany). siRNA is added to 100 ml PBS at a final concentration of 2 mmol/ml. After adding HiPerFect transfection reagent, the mixture is incubated for 10 min at RT. In order to remove the excess of micelles, the exosomes are re-isolated using aldehyde/sulfate latex beads. The chemical transfection of CRISPR Cas into exosomes may be conducted similarly to siRNA. The exosomes may be co-cultured with monocytes and lymphocytes isolated from the peripheral blood of healthy donors. Therefore, it may be contemplated that exosomes containing the DNA targeting agent according to the invention as described herein, such as by means of example CRISPR Cas may be introduced to monocytes and lymphocytes of and autologously reintroduced into a human. Accordingly, delivery or administration according to the invention may beperformed using plasma exosomes.

Liposomes

Delivery or administration according to the invention can be performed with liposomes. Liposomes are spherical vesicle structures composed of a uni- or multilamellar lipid bilayer surrounding internal aqueous compartments and a relatively impermeable outer lipophilic phospholipid bilayer. Liposomes have gained considerable attention as drug delivery carriers because they are biocompatible, nontoxic, can deliver both hydrophilic and lipophilic drug molecules, protect their cargo from degradation by plasma enzymes, and transport their load across biological membranes and the blood brain barrier (BBB) (see, e.g., Spuch and Navarro, Journal of Drug Delivery, vol. 2011, Article ID 469679, 12 pages, 2011. doi:10.1155/2011/469679 for review).

Liposomes can be made from several different types of lipids; however, phospholipids are most commonly used to generate liposomes as drug carriers. Although liposome formation is spontaneous when a lipid film is mixed with an aqueous solution, it can also be expedited by applying force in the form of shaking by using a homogenizer, sonicator, or an extrusion apparatus (see, e.g., Spuch and Navarro, Journal of Drug Delivery, vol. 2011, Article ID 469679, 12 pages, 2011. doi:10.1155/2011/469679 for review).

Several other additives may be added to liposomes in order to modify their structure and properties. For instance, either cholesterol or sphingomyelin may be added to the liposomal mixture in order to help stabilize the liposomal structure and to prevent the leakage of the liposomal inner cargo. Further, liposomes are prepared from hydrogenated egg phosphatidylcholine or egg phosphatidylcholine, cholesterol, and dicetyl phosphate, and their mean vesicle sizes were adjusted to about 50 and 100 nm. (see, e.g., Spuch and Navarro, Journal of Drug Delivery, vol. 2011, Article ID 469679, 12 pages, 2011. doi:10.1155/2011/469679 for review).

A liposome formulation may be mainly comprised of natural phospholipids and lipids such as 1,2-distearoryl-sn-glycero-3-phosphatidyl choline (DSPC), sphingomyelin, egg phosphatidylcholines and monosialoganglioside. Since this formulation is made up of phospholipids only, liposomal formulations have encountered many challenges, one of the ones being the instability in plasma. Several attempts to overcome these challenges have been made, specifically in the manipulation of the lipid membrane. One of these attempts focused on the manipulation of cholesterol. Addition of cholesterol to conventional formulations reduces rapid release of the encapsulated bioactive compound into the plasma or 1,2-dioleoyl-sn-glycero-3-phosphoethanolamine (DOPE) increases the stability (see, e.g., Spuch and Navarro, Journal of Drug Delivery, vol. 2011, Article ID 469679, 12 pages, 2011. doi:10.1155/2011/469679 for review).

In a particularly advantageous embodiment, Trojan Horse liposomes (also known as Molecular Trojan Horses) are desirable and protocols may be found at cshprotocols.cshlp.org/content/2010/4/pdb.prot5407.1ong. These particles allow delivery of a transgene to the entire brain after an intravascular injection. Without being bound by limitation, it is believed that neutral lipid particles with specific antibodies conjugated to surface allow crossing of the blood brain barrier via endocytosis. Applicant postulates utilizing Trojan Horse Liposomes to deliver the the DNA targeting agent according to the invention as described herein, such as by means of example the CRISPR family of nucleases to the brain via an intravascular injection, which would allow whole brain transgenic animals without the need for embryonic manipulation. About 1-5 g of DNA or RNA may be contemplated for in vivo administration in liposomes.

In another embodiment, the the DNA targeting agent according to the invention as described herein, such as by means of example the CRISPR Cas system may be administered in liposomes, such as a stable nucleic-acid-lipid particle (SNALP) (see, e.g., Morrissey et al., Nature Biotechnology, Vol. 23, No. 8, August 2005). Daily intravenous injections of about 1, 3 or 5 mg/kg/day of a specific CRISPR Cas targeted in a SNALP are contemplated. The daily treatment may be over about three days and then weekly for about five weeks. In another embodiment, a specific CRISPR Cas encapsulated SNALP) administered by intravenous injection to at doses of about 1 or 2.5 mg/kg are also contemplated (see, e.g., Zimmerman et al., Nature Letters, Vol. 441, 4 May 2006). The SNALP formulation may contain the lipids 3-N-[(wmethoxypoly(ethylene glycol) 2000) carbamoyl]-1,2-dimyristyloxy-propylamine (PEG-C-DMA), 1,2-dilinoleyloxy-N,N-dimethyl-3-aminopropane (DLinDMA), 1,2-distearoyl-sn-glycero-3-phosphocholine (DSPC) and cholesterol, in a 2:40:10:48 molar percent ratio (see, e.g., Zimmerman et al., Nature Letters, Vol. 441, 4 May 2006).

In another embodiment, stable nucleic-acid-lipid particles (SNALPs) have proven to be effective delivery molecules to highly vascularized HepG2-derived liver tumors but not in poorly vascularized HCT-116 derived liver tumors (see, e.g., Li, Gene Therapy (2012) 19, 775-780). The SNALP liposomes may be prepared by formulating D-Lin-DMA and PEG-C-DMA with distearoylphosphatidylcholine (DSPC), Cholesterol and siRNA using a 25:1 lipid/siRNA ratio and a 48/40/10/2 molar ratio of Cholesterol/D-Lin-DMA/DSPC/PEG-C-DMA. The resulted SNALP liposomes are about 80-100 nm in size.

In yet another embodiment, a SNALP may comprise synthetic cholesterol (Sigma-Aldrich, St Louis, Mo., USA), dipalmitoylphosphatidylcholine (Avanti Polar Lipids, Alabaster, Ala., USA), 3-N-[(w-methoxy poly(ethylene glycol)2000)carbamoyl]-1,2-dimyrestyloxypropylamine, and cationic 1,2-dilinoleyloxy-3-N,Ndimethylaminopropane (see, e.g., Geisbert et al., Lancet 2010; 375: 1896-905). A dosage of about 2 mg/kg total CRISPR Cas per dose administered as, for example, a bolus intravenous infusion may be contemplated.

In yet another embodiment, a SNALP may comprise synthetic cholesterol (Sigma-Aldrich), 1,2-distearoyl-sn-glycero-3-phosphocholine (DSPC; Avanti Polar Lipids Inc.), PEG-cDMA, and 1,2-dilinoleyloxy-3-(N;N-dimethyl)aminopropane (DLinDMA) (see, e.g., Judge, J. Clin. Invest. 119:661-673 (2009)). Formulations used for in vivo studies may comprise a final lipid/RNA mass ratio of about 9:1.

The safety profile of RNAi nanomedicines has been reviewed by Barros and Gollob of Alnylam Pharmaceuticals (see, e.g., Advanced Drug Delivery Reviews 64 (2012) 1730-1737). The stable nucleic acid lipid particle (SNALP) is comprised of four different lipids—an ionizable lipid (DLinDMA) that is cationic at low pH, a neutral helper lipid, cholesterol, and a diffusible polyethylene glycol (PEG)-lipid. The particle is approximately 80 nm in diameter and is charge-neutral at physiologic pH. During formulation, the ionizable lipid serves to condense lipid with the anionic RNA during particle formation. When positively charged under increasingly acidic endosomal conditions, the ionizable lipid also mediates the fusion of SNALP with the endosomal membrane enabling release of RNA into the cytoplasm. The PEG-lipid stabilizes the particle and reduces aggregation during formulation, and subsequently provides a neutral hydrophilic exterior that improves pharmacokinetic properties.

To date, two clinical programs have been initiated using SNALP formulations with RNA. Tekmira Pharmaceuticals recently completed a phase I single-dose study of SNALP-ApoB in adult volunteers with elevated LDL cholesterol. ApoB is predominantly expressed in the liver and jejunum and is essential for the assembly and secretion of VLDL and LDL. Seventeen subjects received a single dose of SNALP-ApoB (dose escalation across 7 dose levels). There was no evidence of liver toxicity (anticipated as the potential dose-limiting toxicity based on preclinical studies). One (of two) subjects at the highest dose experienced flu-like symptoms consistent with immune system stimulation, and the decision was made to conclude the trial.

Alnylam Pharmaceuticals has similarly advanced ALN-TTR01, which employs the SNALP technology described above and targets hepatocyte production of both mutant and wild-type TTR to treat TTR amyloidosis (ATTR). Three ATTR syndromes have been described: familial amyloidotic polyneuropathy (FAP) and familial amyloidotic cardiomyopathy (FAC)—both caused by autosomal dominant mutations in TTR; and senile systemic amyloidosis (SSA) cause by wildtype TTR. A placebo-controlled, single dose-escalation phase I trial of ALN-TTR01 was recently completed in patients with ATTR. ALN-TTR01 was administered as a 15-minute IV infusion to 31 patients (23 with study drug and 8 with placebo) within a dose range of 0.01 to 1.0 mg/kg (based on siRNA). Treatment was well tolerated with no significant increases in liver function tests. Infusion-related reactions were noted in 3 of 23 patients at ≥0.4 mg/kg; all responded to slowing of the infusion rate and all continued on study. Minimal and transient elevations of serum cytokines IL-6, IP-10 and IL-1ra were noted in two patients at the highest dose of 1 mg/kg (as anticipated from preclinical and NHP studies). Lowering of serum TTR, the expected pharmacodynamics effect of ALN-TTR01, was observed at 1 mg/kg.

In yet another embodiment, a SNALP may be made by solubilizing a cationic lipid, DSPC, cholesterol and PEG-lipid e.g., in ethanol, e.g., at a molar ratio of 40:10:40:10, respectively (see, Semple et al., Nature Niotechnology, Volume 28 Number 2 February 2010, pp. 172-177). The lipid mixture was added to an aqueous buffer (50 mM citrate, pH 4) with mixing to a final ethanol and lipid concentration of 30% (vol/vol) and 6.1 mg/ml, respectively, and allowed to equilibrate at 22° C. for 2 min before extrusion. The hydrated lipids were extruded through two stacked 80 nm pore-sized filters (Nuclepore) at 22° C. using a Lipex Extruder (Northern Lipids) until a vesicle diameter of 70-90 nm, as determined by dynamic light scattering analysis, was obtained. This generally required 1-3 passes. The siRNA (solubilized in a 50 mM citrate, pH 4 aqueous solution containing 30% ethanol) was added to the pre-equilibrated (35° C.) vesicles at a rate of ˜5 ml/min with mixing. After a final target siRNA/lipid ratio of 0.06 (wt/wt) was reached, the mixture was incubated for a further 30 min at 35° C. to allow vesicle reorganization and encapsulation of the siRNA. The ethanol was then removed and the external buffer replaced with PBS (155 mM NaCl, 3 mM Na₂HPO₄, 1 mM KH₂PO₄, pH 7.5) by either dialysis or tangential flow diafiltration. siRNA were encapsulated in SNALP using a controlled step-wise dilution method process. The lipid constituents of KC2-SNALP were DLin-KC2-DMA (cationic lipid), dipalmitoylphosphatidylcholine (DPPC; Avanti Polar Lipids), synthetic cholesterol (Sigma) and PEG-C-DMA used at a molar ratio of 57.1:7.1:34.3:1.4. Upon formation of the loaded particles, SNALP were dialyzed against PBS and filter sterilized through a 0.2 μm filter before use. Mean particle sizes were 75-85 nm and 90-95% of the siRNA was encapsulated within the lipid particles. The final siRNA/lipid ratio in formulations used for in vivo testing was ˜0.15 (wt/wt). LNP-siRNA systems containing Factor VII siRNA were diluted to the appropriate concentrations in sterile PBS immediately before use and the formulations were administered intravenously through the lateral tail vein in a total volume of 10 ml/kg. This method and these delivery systems may be extrapolated to the CRISPR Cas system of the present invention.

Other Lipids

Other cationic lipids, such as amino lipid 2,2-dilinoleyl-4-dimethylaminoethyl[1,3]-dioxolane (DLin-KC2-DMA) may be utilized to encapsulate the DNA targeting agent according to the invention as described herein, such as by means of example CRISPR Cas or components thereof or nucleic acid molecule(s) coding therefor e.g., similar to SiRNA (see, e.g., Jayaraman, Angew. Chem. Int. Ed. 2012, 51, 8529-8533), and hence may be employed in the practice of the invention. A preformed vesicle with the following lipid composition may be contemplated: amino lipid, di stearoylphosphatidylcholine (DSPC), cholesterol and (R)-2,3-bis(octadecyloxy) propyl-1-(methoxy poly(ethylene glycol)2000)propylcarbamate (PEG-lipid) in the molar ratio 40/10/40/10, respectively, and a FVII siRNA/total lipid ratio of approximately 0.05 (w/w). To ensure a narrow particle size distribution in the range of 70-90 nm and a low polydispersity index of 0.11±0.04 (n=56), the particles may be extruded up to three times through 80 nm membranes prior to adding the CRISPR Cas RNA. Particles containing the highly potent amino lipid 16 may be used, in which the molar ratio of the four lipid components 16, DSPC, cholesterol and PEG-lipid (50/10/38.5/1.5) which may be further optimized to enhance in vivo activity.

Michael S D Kormann et al. (“Expression of therapeutic proteins after delivery of chemically modified mRNA in mice: Nature Biotechnology, Volume:29, Pages: 154-157 (2011)) describes the use of lipid envelopes to deliver RNA. Use of lipid envelopes is also preferred in the present invention.

In another embodiment, lipids may be formulated with the CRISPR Cas system of the present invention to form lipid particles (LNPs). Lipids include, but are not limited to, DLin-KC2-DMA4, C12-200 and colipids disteroylphosphatidyl choline, cholesterol, and PEG-DMG may be formulated with CRISPR Cas instead of siRNA (see, e.g., Novobrantseva, Molecular Therapy—Nucleic Acids (2012) 1, e4; doi:10.1038/mtna.2011.3) using a spontaneous vesicle formation procedure. The component molar ratio may be about 50/10/38.5/1.5 (DLin-KC2-DMA or C12-200/disteroylphosphatidyl choline/cholesterol/PEG-DMG). The final lipid:siRNA weight ratio may be ˜12:1 and 9:1 in the case of DLin-KC2-DMA and C12-200 lipid particles (LNPs), respectively. The formulations may have mean particle diameters of ˜80 nm with >90% entrapment efficiency. A 3 mg/kg dose may be contemplated.

Tekmira has a portfolio of approximately 95 patent families, in the U.S. and abroad, that are directed to various aspects of LNPs and LNP formulations (see, e.g., U.S. Pat. Nos. 7,982,027; 7,799,565; 8,058,069; 8,283,333; 7,901,708; 7,745,651; 7,803,397; 8,101,741; 8,188,263; 7,915,399; 8,236,943 and 7,838,658 and European Pat. Nos 1766035; 1519714; 1781593 and 1664316), all of which may be used and/or adapted to the present invention.

The the DNA targeting agent according to the invention as described herein, such as by means of example CRISPR Cas system or components thereof or nucleic acid molecule(s) coding therefor may be delivered encapsulated in PLGA Microspheres such as that further described in US published applications 20130252281 and 20130245107 and 20130244279 (assigned to Moderna Therapeutics) which relate to aspects of formulation of compositions comprising modified nucleic acid molecules which may encode a protein, a protein precursor, or a partially or fully processed form of the protein or a protein precursor. The formulation may have a molar ratio 50:10:38.5:1.5-3.0 (cationic lipid:fusogenic lipid:cholesterol:PEG lipid). The PEG lipid may be selected from, but is not limited to PEG-c-DOMG, PEG-DMG. The fusogenic lipid may be DSPC. See also, Schrum et al., Delivery and Formulation of Engineered Nucleic Acids, US published application 20120251618.

Nanomerics' technology addresses bioavailability challenges for a broad range of therapeutics, including low molecular weight hydrophobic drugs, peptides, and nucleic acid based therapeutics (plasmid, siRNA, miRNA). Specific administration routes for which the technology has demonstrated clear advantages include the oral route, transport across the blood-brain-barrier, delivery to solid tumours, as well as to the eye. See, e.g., Mazza et al., 2013, ACS Nano. 2013 Feb. 26; 7(2):1016-26; Uchegbu and Siew, 2013, J Pharm Sci. 102(2):305-10 and Lalatsa et al., 2012, J Control Release. 2012 Jul. 20; 161(2):523-36.

US Patent Publication No. 20050019923 describes cationic dendrimers for delivering bioactive molecules, such as polynucleotide molecules, peptides and polypeptides and/or pharmaceutical agents, to a mammalian body. The dendrimers are suitable for targeting the delivery of the bioactive molecules to, for example, the liver, spleen, lung, kidney or heart (or even the brain). Dendrimers are synthetic 3-dimensional macromolecules that are prepared in a step-wise fashion from simple branched monomer units, the nature and functionality of which can be easily controlled and varied. Dendrimers are synthesised from the repeated addition of building blocks to a multifunctional core (divergent approach to synthesis), or towards a multifunctional core (convergent approach to synthesis) and each addition of a 3-dimensional shell of building blocks leads to the formation of a higher generation of the dendrimers. Polypropylenimine dendrimers start from a diaminobutane core to which is added twice the number of amino groups by a double Michael addition of acrylonitrile to the primary amines followed by the hydrogenation of the nitriles. This results in a doubling of the amino groups. Polypropylenimine dendrimers contain 100% protonable nitrogens and up to 64 terminal amino groups (generation 5, DAB 64). Protonable groups are usually amine groups which are able to accept protons at neutral pH. The use of dendrimers as gene delivery agents has largely focused on the use of the polyamidoamine. and phosphorous containing compounds with a mixture of amine/amide or N—P(O₂)S as the conjugating units respectively with no work being reported on the use of the lower generation polypropylenimine dendrimers for gene delivery. Polypropylenimine dendrimers have also been studied as pH sensitive controlled release systems for drug delivery and for their encapsulation of guest molecules when chemically modified by peripheral amino acid groups. The cytotoxicity and interaction of polypropylenimine dendrimers with DNA as well as the transfection efficacy of DAB 64 has also been studied.

US Patent Publication No. 20050019923 is based upon the observation that, contrary to earlier reports, cationic dendrimers, such as polypropylenimine dendrimers, display suitable properties, such as specific targeting and low toxicity, for use in the targeted delivery of bioactive molecules, such as genetic material. In addition, derivatives of the cationic dendrimer also display suitable properties for the targeted delivery of bioactive molecules. See also, Bioactive Polymers, US published application 20080267903, which discloses “Various polymers, including cationic polyamine polymers and dendrimeric polymers, are shown to possess anti-proliferative activity, and may therefore be useful for treatment of disorders characterised by undesirable cellular proliferation such as neoplasms and tumours, inflammatory disorders (including autoimmune disorders), psoriasis and atherosclerosis. The polymers may be used alone as active agents, or as delivery vehicles for other therapeutic agents, such as drug molecules or nucleic acids for gene therapy. In such cases, the polymers' own intrinsic anti-tumour activity may complement the activity of the agent to be delivered.” The disclosures of these patent publications may be employed in conjunction with herein teachings for delivery of CRISPR Cas system(s) or component(s) thereof or nucleic acid molecule(s) coding therefor.

Supercharged Proteins

Supercharged proteins are a class of engineered or naturally occurring proteins with unusually high positive or negative net theoretical charge and may be employed in delivery of the DNA targeting agent according to the invention as described herein, such as by means of example CRISPR Cas system(s) or component(s) thereof or nucleic acid molecule(s) coding therefor. Both supernegatively and superpositively charged proteins exhibit a remarkable ability to withstand thermally or chemically induced aggregation. Superpositively charged proteins are also able to penetrate mammalian cells. Associating cargo with these proteins, such as plasmid DNA, RNA, or other proteins, can enable the functional delivery of these macromolecules into mammalian cells both in vitro and in vivo. David Liu's lab reported the creation and characterization of supercharged proteins in 2007 (Lawrence et al., 2007, Journal of the American Chemical Society 129, 10110-10112).

The nonviral delivery of RNA and plasmid DNA into mammalian cells are valuable both for research and therapeutic applications (Akinc et al., 2010, Nat. Biotech. 26, 561-569). Purified+36 GFP protein (or other superpositively charged protein) is mixed with RNAs in the appropriate serum-free media and allowed to complex prior addition to cells. Inclusion of serum at this stage inhibits formation of the supercharged protein-RNA complexes and reduces the effectiveness of the treatment. The following protocol has been found to be effective for a variety of cell lines (McNaughton et al., 2009, Proc. Natl. Acad. Sci. USA 106, 6111-6116) (However, pilot experiments varying the dose of protein and RNA should be performed to optimize the procedure for specific cell lines): (1) One day before treatment, plate 1×10⁵ cells per well in a 48-well plate. (2) On the day of treatment, dilute purified +36 GFP protein in serumfree media to a final concentration 200 nM. Add RNA to a final concentration of 50 nM. Vortex to mix and incubate at room temperature for 10 min. (3) During incubation, aspirate media from cells and wash once with PBS. (4) Following incubation of +36 GFP and RNA, add the protein-RNA complexes to cells. (5) Incubate cells with complexes at 37° C. for 4 h. (6) Following incubation, aspirate the media and wash three times with 20 U/mL heparin PBS. Incubate cells with serum-containing media for a further 48 h or longer depending upon the assay for activity. (7) Analyze cells by immunoblot, qPCR, phenotypic assay, or other appropriate method.

David Liu's lab has further found +36 GFP to be an effective plasmid delivery reagent in a range of cells. As plasmid DNA is a larger cargo than siRNA, proportionately more +36 GFP protein is required to effectively complex plasmids. For effective plasmid delivery Applicants have developed a variant of +36 GFP bearing a C-terminal HA2 peptide tag, a known endosome-disrupting peptide derived from the influenza virus hemagglutinin protein. The following protocol has been effective in a variety of cells, but as above it is advised that plasmid DNA and supercharged protein doses be optimized for specific cell lines and delivery applications: (1) One day before treatment, plate 1×10⁵ per well in a 48-well plate. (2) On the day of treatment, dilute purified 36 GFP protein in serumfree media to a final concentration 2 mM. Add 1 mg of plasmid DNA. Vortex to mix and incubate at room temperature for 10 min. (3) During incubation, aspirate media from cells and wash once with PBS. (4) Following incubation of 36 GFP and plasmid DNA, gently add the protein-DNA complexes to cells. (5) Incubate cells with complexes at 37 C for 4 h. (6) Following incubation, aspirate the media and wash with PBS. Incubate cells in serum-containing media and incubate for a further 24-48 h. (7) Analyze plasmid delivery (e.g., by plasmid-driven gene expression) as appropriate. See also, e.g., McNaughton et al., Proc. Natl. Acad. Sci. USA 106, 6111-6116 (2009); Cronican et al., ACS Chemical Biology 5, 747-752 (2010); Cronican et al., Chemistry & Biology 18, 833-838 (2011); Thompson et al., Methods in Enzymology 503, 293-319 (2012); Thompson, D. B., et al., Chemistry & Biology 19 (7), 831-843 (2012). The methods of the super charged proteins may be used and/or adapted for delivery of the CRISPR Cas system of the present invention. These systems of Dr. Lui and documents herein in inconjunction with herein teachints can be employed in the delivery of the DNA targeting agent according to the invention as described herein, such as by means of example CRISPR Cas system(s) or component(s) thereof or nucleic acid molecule(s) coding therefor.

Cell Penetrating Peptides (CPPs)

In yet another embodiment, cell penetrating peptides (CPPs) are contemplated for the delivery of the the DNA targeting agent according to the invention as described herein, such as by means of example CRISPR Cas system. CPPs are short peptides that facilitate cellular uptake of various molecular cargo (from nanosize particles to small chemical molecules and large fragments of DNA). The term “cargo” as used herein includes but is not limited to the group consisting of therapeutic agents, diagnostic probes, peptides, nucleic acids, antisense oligonucleotides, plasmids, proteins, particles, liposomes, chromophores, small molecules and radioactive materials. In aspects of the invention, the cargo may also comprise any component of the the DNA targeting agent according to the invention as described herein, such as by means of example CRISPR Cas system or the entire functional CRISPR Cas system. Aspects of the present invention further provide methods for delivering a desired cargo into a subject comprising: (a) preparing a complex comprising the cell penetrating peptide of the present invention and a desired cargo, and (b) orally, intraarticularly, intraperitoneally, intrathecally, intrarterially, intranasally, intraparenchymally, subcutaneously, intramuscularly, intravenously, dermally, intrarectally, or topically administering the complex to a subject. The cargo is associated with the peptides either through chemical linkage via covalent bonds or through non-covalent interactions.

The function of the CPPs are to deliver the cargo into cells, a process that commonly occurs through endocytosis with the cargo delivered to the endosomes of living mammalian cells. Cell-penetrating peptides are of different sizes, amino acid sequences, and charges but all CPPs have one distinct characteristic, which is the ability to translocate the plasma membrane and facilitate the delivery of various molecular cargoes to the cytoplasm or an organelle. CPP translocation may be classified into three main entry mechanisms: direct penetration in the membrane, endocytosis-mediated entry, and translocation through the formation of a transitory structure. CPPs have found numerous applications in medicine as drug delivery agents in the treatment of different diseases including cancer and virus inhibitors, as well as contrast agents for cell labeling. Examples of the latter include acting as a carrier for GFP, Mill contrast agents, or quantum dots. CPPs hold great potential as in vitro and in vivo delivery vectors for use in research and medicine. CPPs typically have an amino acid composition that either contains a high relative abundance of positively charged amino acids such as lysine or arginine or has sequences that contain an alternating pattern of polar/charged amino acids and non-polar, hydrophobic amino acids. These two types of structures are referred to as polycationic or amphipathic, respectively. A third class of CPPs are the hydrophobic peptides, containing only apolar residues, with low net charge or have hydrophobic amino acid groups that are crucial for cellular uptake. One of the initial CPPs discovered was the trans-activating transcriptional activator (Tat) from Human Immunodeficiency Virus 1 (HIV-1) which was found to be efficiently taken up from the surrounding media by numerous cell types in culture. Since then, the number of known CPPs has expanded considerably and small molecule synthetic analogues with more effective protein transduction properties have been generated. CPPs include but are not limited to Penetratin, Tat (48-60), Transportan, and (R-AhX-R)4 (Ahx=aminohexanoyl) (SEQ ID NO: 17).

U.S. Pat. No. 8,372,951, provides a CPP derived from eosinophil cationic protein (ECP) which exhibits highly cell-penetrating efficiency and low toxicity. Aspects of delivering the CPP with its cargo into a vertebrate subject are also provided. Further aspects of CPPs and their delivery are described in U.S. Pat. No. 8,575,305; 8;614,194 and 8,044,019. CPPs can be used to deliver the CRISPR-Cas system or components thereof. That CPPs can be employed to deliver the CRISPR-Cas system or components thereof is also provided in the manuscript “Gene disruption by cell-penetrating peptide-mediated delivery of Cas9 protein and guide RNA”, by Suresh Ramakrishna, Abu-Bonsrah Kwaku Dad, Jagadish Beloor, et al. Genome Res. 2014 April 2. [Epub ahead of print], incorporated by reference in its entirety, wherein it is demonstrated that treatment with CPP-conjugated recombinant Cas9 protein and CPP-complexed guide RNAs lead to endogenous gene disruptions in human cell lines. In the paper the Cas9 protein was conjugated to CPP via a thioether bond, whereas the guide RNA was complexed with CPP, forming condensed, positively charged particles. It was shown that simultaneous and sequential treatment of human cells, including embryonic stem cells, dermal fibroblasts, HEK293T cells, HeLa cells, and embryonic carcinoma cells, with the modified Cas9 and guide RNA led to efficient gene disruptions with reduced off-target mutations relative to plasmid transfections.

Implantable Devices

In another embodiment, implantable devices are also contemplated for delivery of the the DNA targeting agent according to the invention as described herein, such as by means of example the CRISPR Cas system or component(s) thereof or nucleic acid molecule(s) coding therefor. For example, US Patent Publication 20110195123 discloses an implantable medical device which elutes a drug locally and in prolonged period is provided, including several types of such a device, the treatment modes of implementation and methods of implantation. The device comprising of polymeric substrate, such as a matrix for example, that is used as the device body, and drugs, and in some cases additional scaffolding materials, such as metals or additional polymers, and materials to enhance visibility and imaging. An implantable delivery device can be advantageous in providing release locally and over a prolonged period, where drug is released directly to the extracellular matrix (ECM) of the diseased area such as tumor, inflammation, degeneration or for symptomatic objectives, or to injured smooth muscle cells, or for prevention. One kind of drug is RNA, as disclosed above, and this system may be used/and or adapted to the the DNA targeting agent according to the invention as described herein, such as by means of example CRISPR Cas system of the present invention. The modes of implantation in some embodiments are existing implantation procedures that are developed and used today for other treatments, including brachytherapy and needle biopsy. In such cases the dimensions of the new implant described in this invention are similar to the original implant. Typically a few devices are implanted during the same treatment procedure.

As described in US Patent Publication 20110195123, there is provided a drug delivery implantable or insertable system, including systems applicable to a cavity such as the abdominal cavity and/or any other type of administration in which the drug delivery system is not anchored or attached, comprising a biostable and/or degradable and/or bioabsorbable polymeric substrate, which may for example optionally be a matrix. It should be noted that the term “insertion” also includes implantation. The drug delivery system is preferably implemented as a “Loder” as described in US Patent Publication 20110195123.

The polymer or plurality of polymers are biocompatible, incorporating an agent and/or plurality of agents, enabling the release of agent at a controlled rate, wherein the total volume of the polymeric substrate, such as a matrix for example, in some embodiments is optionally and preferably no greater than a maximum volume that permits a therapeutic level of the agent to be reached. As a non-limiting example, such a volume is preferably within the range of 0.1 m³ to 1000 mm³, as required by the volume for the agent load. The Loder may optionally be larger, for example when incorporated with a device whose size is determined by functionality, for example and without limitation, a knee joint, an intra-uterine or cervical ring and the like.

The drug delivery system (for delivering the composition) is designed in some embodiments to preferably employ degradable polymers, wherein the main release mechanism is bulk erosion; or in some embodiments, non degradable, or slowly degraded polymers are used, wherein the main release mechanism is diffusion rather than bulk erosion, so that the outer part functions as membrane, and its internal part functions as a drug reservoir, which practically is not affected by the surroundings for an extended period (for example from about a week to about a few months). Combinations of different polymers with different release mechanisms may also optionally be used. The concentration gradient at the surface is preferably maintained effectively constant during a significant period of the total drug releasing period, and therefore the diffusion rate is effectively constant (termed “zero mode” diffusion). By the term “constant” it is meant a diffusion rate that is preferably maintained above the lower threshold of therapeutic effectiveness, but which may still optionally feature an initial burst and/or may fluctuate, for example increasing and decreasing to a certain degree. The diffusion rate is preferably so maintained for a prolonged period, and it can be considered constant to a certain level to optimize the therapeutically effective period, for example the effective silencing period.

The drug delivery system optionally and preferably is designed to shield the nucleotide based therapeutic agent from degradation, whether chemical in nature or due to attack from enzymes and other factors in the body of the subject.

The drug delivery system as described in US Patent Publication 20110195123 is optionally associated with sensing and/or activation appliances that are operated at and/or after implantation of the device, by non and/or minimally invasive methods of activation and/or acceleration/deceleration, for example optionally including but not limited to thermal heating and cooling, laser beams, and ultrasonic, including focused ultrasound and/or RF (radiofrequency) methods or devices.

According to some embodiments of US Patent Publication 20110195123, the site for local delivery may optionally include target sites characterized by high abnormal proliferation of cells, and suppressed apoptosis, including tumors, active and or chronic inflammation and infection including autoimmune diseases states, degenerating tissue including muscle and nervous tissue, chronic pain, degenerative sites, and location of bone fractures and other wound locations for enhancement of regeneration of tissue, and injured cardiac, smooth and striated muscle.

The site for implantation of the composition, or target site, preferably features a radius, area and/or volume that is sufficiently small for targeted local delivery. For example, the target site optionally has a diameter in a range of from about 0.1 mm to about 5 cm.

The location of the target site is preferably selected for maximum therapeutic efficacy. For example, the composition of the drug delivery system (optionally with a device for implantation as described above) is optionally and preferably implanted within or in the proximity of a tumor environment, or the blood supply associated thereof.

For example the composition (optionally with the device) is optionally implanted within or in the proximity to pancreas, prostate, breast, liver, via the nipple, within the vascular system and so forth.

The target location is optionally selected from the group consisting of (as non-limiting examples only, as optionally any site within the body may be suitable for implanting a Loder): 1. brain at degenerative sites like in Parkinson or Alzheimer disease at the basal ganglia, white and gray matter; 2. spine as in the case of amyotrophic lateral sclerosis (ALS); 3. uterine cervix to prevent HPV infection; 4. active and chronic inflammatory joints; 5. dermis as in the case of psoriasis; 6. sympathetic and sensoric nervous sites for analgesic effect; 7. Intra osseous implantation; 8. acute and chronic infection sites; 9. Intra vaginal; 10. Inner ear—auditory system, labyrinth of the inner ear, vestibular system; 11. Intra tracheal; 12. Intra-cardiac; coronary, epicardiac; 13. urinary bladder; 14. biliary system; 15. parenchymal tissue including and not limited to the kidney, liver, spleen; 16. lymph nodes; 17. salivary glands; 18. dental gums; 19. Intra-articular (into joints); 20. Intra-ocular; 21. Brain tissue; 22. Brain ventricles; 23. Cavities, including abdominal cavity (for example but without limitation, for ovary cancer); 24. Intra esophageal and 25. Intra rectal.

Optionally insertion of the system (for example a device containing the composition) is associated with injection of material to the ECM at the target site and the vicinity of that site to affect local pH and/or temperature and/or other biological factors affecting the diffusion of the drug and/or drug kinetics in the ECM, of the target site and the vicinity of such a site.

Optionally, according to some embodiments, the release of said agent could be associated with sensing and/or activation appliances that are operated prior and/or at and/or after insertion, by non and/or minimally invasive and/or else methods of activation and/or acceleration/deceleration, including laser beam, radiation, thermal heating and cooling, and ultrasonic, including focused ultrasound and/or RF (radiofrequency) methods or devices, and chemical activators.

According to other embodiments of US Patent Publication 20110195123, the drug preferably comprises a RNA, for example for localized cancer cases in breast, pancreas, brain, kidney, bladder, lung, and prostate as described below. Although exemplified with RNAi, many drugs are applicable to be encapsulated in Loder, and can be used in association with this invention, as long as such drugs can be encapsulated with the Loder substrate, such as a matrix for example, and this system may be used and/or adapted to deliver the CRISPR Cas system of the present invention.

As another example of a specific application, neuro and muscular degenerative diseases develop due to abnormal gene expression. Local delivery of RNAs may have therapeutic properties for interfering with such abnormal gene expression. Local delivery of anti apoptotic, anti inflammatory and anti degenerative drugs including small drugs and macromolecules may also optionally be therapeutic. In such cases the Loder is applied for prolonged release at constant rate and/or through a dedicated device that is implanted separately. All of this may be used and/or adapted to the the DNA targeting agent according to the invention as described herein, such as by means of example CRISPR Cas system of the present invention.

As yet another example of a specific application, psychiatric and cognitive disorders are treated with gene modifiers. Gene knockdown is a treatment option. Loders locally delivering agents to central nervous system sites are therapeutic options for psychiatric and cognitive disorders including but not limited to psychosis, bi-polar diseases, neurotic disorders and behavioral maladies. The Loders could also deliver locally drugs including small drugs and macromolecules upon implantation at specific brain sites. All of this may be used and/or adapted to the CRISPR Cas system of the present invention.

As another example of a specific application, silencing of innate and/or adaptive immune mediators at local sites enables the prevention of organ transplant rejection. Local delivery of RNAs and immunomodulating reagents with the Loder implanted into the transplanted organ and/or the implanted site renders local immune suppression by repelling immune cells such as CD8 activated against the transplanted organ. All of this may be used/and or adapted to the the DNA targeting agent according to the invention as described herein, such as by means of example CRISPR Cas system of the present invention.

As another example of a specific application, vascular growth factors including VEGFs and angiogenin and others are essential for neovascularization. Local delivery of the factors, peptides, peptidomimetics, or suppressing their repressors is an important therapeutic modality; silencing the repressors and local delivery of the factors, peptides, macromolecules and small drugs stimulating angiogenesis with the Loder is therapeutic for peripheral, systemic and cardiac vascular disease.

The method of insertion, such as implantation, may optionally already be used for other types of tissue implantation and/or for insertions and/or for sampling tissues, optionally without modifications, or alternatively optionally only with non-major modifications in such methods. Such methods optionally include but are not limited to brachytherapy methods, biopsy, endoscopy with and/or without ultrasound, such as ERCP, stereotactic methods into the brain tissue, Laparoscopy, including implantation with a laparoscope into joints, abdominal organs, the bladder wall and body cavities.

Implantable device technology herein discussed can be employed with herein teachings and hence by this disclosure and the knowledge in the art, the DNA targeting agent according to the invention as described herein, such as by means of example CRISPR-Cas system or components thereof or nucleic acid molecules thereof or encoding or providing components may be delivered via an implantable device.

The present application also contemplates an inducible CRISPR Cas system. Reference is made to international patent application Serial No. PCT/US13/51418 filed Jul. 21, 2013, which published as WO2014/018423 on Jan. 30, 2014.

In one aspect the invention provides a DNA targeting agent according to the invention as described herein, such as by means of example a non-naturally occurring or engineered CRISPR Cas system which may comprise at least one switch wherein the activity of said CRISPR Cas system is controlled by contact with at least one inducer energy source as to the switch. In an embodiment of the invention the control as to the at least one switch or the activity of said CRISPR Cas system may be activated, enhanced, terminated or repressed. The contact with the at least one inducer energy source may result in a first effect and a second effect.

The first effect may be one or more of nuclear import, nuclear export, recruitment of a secondary component (such as an effector molecule), conformational change (of protein, DNA or RNA), cleavage, release of cargo (such as a caged molecule or a co-factor), association or dissociation. The second effect may be one or more of activation, enhancement, termination or repression of the control as to the at least one switch or the activity of said the DNA targeting agent according to the invention as described herein, such as by means of example CRISPR Cas system. In one embodiment the first effect and the second effect may occur in a cascade.

The invention comprehends that the inducer energy source may be heat, ultrasound, electromagnetic energy or chemical. In a preferred embodiment of the invention, the inducer energy source may be an antibiotic, a small molecule, a hormone, a hormone derivative, a steroid or a steroid derivative. In a more preferred embodiment, the inducer energy source maybe abscisic acid (ABA), doxycycline (DOX), cumate, rapamycin, 4-hydroxytamoxifen (4OHT), estrogen or ecdysone.

The invention provides that the at least one switch may be selected from the group consisting of antibiotic based inducible systems, electromagnetic energy based inducible systems, small molecule based inducible systems, nuclear receptor based inducible systems and hormone based inducible systems. In a more preferred embodiment the at least one switch may be selected from the group consisting of tetracycline (Tet)/DOX inducible systems, light inducible systems, ABA inducible systems, cumate repressor/operator systems, 4OHT/estrogen inducible systems, ecdysone-based inducible systems and FKBP12/FRAP (FKBP12-rapamycin complex) inducible systems.

In one aspect of the invention the inducer energy source is electromagnetic energy.

The electromagnetic energy may be a component of visible light having a wavelength in the range of 450 nm-700 nm. In a preferred embodiment the component of visible light may have a wavelength in the range of 450 nm-500 nm and may be blue light. The blue light may have an intensity of at least 0.2 mW/cm2, or more preferably at least 4 mW/cm2. In another embodiment, the component of visible light may have a wavelength in the range of 620-700 nm and is red light.

In a further aspect, the invention provides a method of controlling a the DNA targeting agent according to the invention as described herein, such as by means of example a non-naturally occurring or engineered CRISPR Cas system, comprising providing said CRISPR Cas system comprising at least one switch wherein the activity of said CRISPR Cas system is controlled by contact with at least one inducer energy source as to the switch.

In an embodiment of the invention, the invention provides methods wherein the control as to the at least one switch or the activity of said the DNA targeting agent according to the invention as described herein, such as by means of example CRISPR Cas system may be activated, enhanced, terminated or repressed. The contact with the at least one inducer energy source may result in a first effect and a second effect. The first effect may be one or more of nuclear import, nuclear export, recruitment of a secondary component (such as an effector molecule), conformational change (of protein, DNA or RNA), cleavage, release of cargo (such as a caged molecule or a co-factor), association or dissociation. The second effect may be one or more of activation, enhancement, termination or repression of the control as to the at least one switch or the activity of said CRISPR Cas system. In one embodiment the first effect and the second effect may occur in a cascade.

The invention comprehends that the inducer energy source may be heat, ultrasound, electromagnetic energy or chemical. In a preferred embodiment of the invention, the inducer energy source may be an antibiotic, a small molecule, a hormone, a hormone derivative, a steroid or a steroid derivative. In a more preferred embodiment, the inducer energy source maybe abscisic acid (ABA), doxycycline (DOX), cumate, rapamycin, 4-hydroxytamoxifen (4OHT), estrogen or ecdysone. The invention provides that the at least one switch may be selected from the group consisting of antibiotic based inducible systems, electromagnetic energy based inducible systems, small molecule based inducible systems, nuclear receptor based inducible systems and hormone based inducible systems. In a more preferred embodiment the at least one switch may be selected from the group consisting of tetracycline (Tet)/DOX inducible systems, light inducible systems, ABA inducible systems, cumate repressor/operator systems, 4OHT/estrogen inducible systems, ecdysone-based inducible systems and FKBP12/FRAP (FKBP12-rapamycin complex) inducible systems.

In one aspect of the methods of the invention the inducer energy source is electromagnetic energy. The electromagnetic energy may be a component of visible light having a wavelength in the range of 450 nm-700 nm. In a preferred embodiment the component of visible light may have a wavelength in the range of 450 nm-500 nm and may be blue light. The blue light may have an intensity of at least 0.2 mW/cm2, or more preferably at least 4 mW/cm2. In another embodiment, the component of visible light may have a wavelength in the range of 620-700 nm and is red light.

In another preferred embodiment of the invention, the inducible effector may be a Light Inducible Transcriptional Effector (LITE). The modularity of the LITE system allows for any number of effector domains to be employed for transcriptional modulation. In yet another preferred embodiment of the invention, the inducible effector may be a chemical. The invention also contemplates an inducible multiplex genome engineering using CRISPR (clustered regularly interspaced short palindromic repeats)/Cas systems.

With respect to use of the CRISPR-Cas system generally, mention is made of the documents, including patent applications, patents, and patent publications cited throughout this disclosure as embodiments of the invention can be used as in those documents. CRISPR-Cas System(s) can be used to perform efficient and cost effective functional genomic screens. Such screens can utilize CRISPR-Cas genome wide libraries. Such screens and libraries can provide for determining the function of genes, cellular pathways genes are involved in, and how any alteration in gene expression can result in a particular biological process. An advantage of the present invention is that the CRISPR system avoids off-target binding and its resulting side effects. This is achieved using systems arranged to have a high degree of sequence specificity for the target DNA.

A genome wide library may comprise a plurality of CRISPR-Cas system guide RNAs, as described herein, comprising guide sequences that are capable of targeting a plurality of target sequences in a plurality of genomic loci in a population of eukaryotic cells. The population of cells may be a population of embryonic stem (ES) cells. The target sequence in the genomic locus may be a non-coding sequence. The non-coding sequence may be an intron, regulatory sequence, splice site, 3′ UTR, 5′ UTR, or polyadenylation signal. Gene function of one or more gene products may be altered by said targeting. The targeting may result in a knockout of gene function. The targeting of a gene product may comprise more than one guide RNA. A gene product may be targeted by 2, 3, 4, 5, 6, 7, 8, 9, or 10 guide RNAs, preferably 3 to 4 per gene. Off-target modifications may be minimized (See, e.g., DNA targeting specificity of RNA-guided Cas9 nucleases. Hsu, P., Scott, D., Weinstein, J., Ran, F A., Konermann, S., Agarwala, V., Li, Y., Fine, E., Wu, X., Shalem, O., Cradick, T J., Marraffini, L A., Bao, G., & Zhang, F. Nat Biotechnol doi:10.1038/nbt.2647 (2013)), incorporated herein by reference. The targeting may be of about 100 or more sequences. The targeting may be of about 1000 or more sequences. The targeting may be of about 20,000 or more sequences. The targeting may be of the entire genome. The targeting may be of a panel of target sequences focused on a relevant or desirable pathway. The pathway may be an immune pathway. The pathway may be a cell division pathway.

One aspect of the invention comprehends a genome wide library that may comprise a plurality of CRISPR-Cas system guide RNAs that may comprise guide sequences that are capable of targeting a plurality of target sequences in a plurality of genomic loci, wherein said targeting results in a knockout of gene function. This library may potentially comprise guide RNAs that target each and every gene in the genome of an organism.

In some embodiments of the invention the organism or subject is a eukaryote (including mammal including human) or a non-human eukaryote or a non-human animal or a non-human mammal. In some embodiments, the organism or subject is a non-human animal, and may be an arthropod, for example, an insect, or may be a nematode. In some methods of the invention the organism or subject is a plant. In some methods of the invention the organism or subject is a mammal or a non-human mammal. A non-human mammal may be for example a rodent (preferably a mouse or a rat), an ungulate, or a primate. In some methods of the invention the organism or subject is algae, including microalgae, or is a fungus.

The knockout of gene function may comprise: introducing into each cell in the population of cells a vector system of one or more vectors comprising an engineered, non-naturally occurring CRISPR-Cas system comprising I. a Cas protein, and II. one or more guide RNAs, wherein components I and II may be same or on different vectors of the system, integrating components I and II into each cell, wherein the guide sequence targets a unique gene in each cell, wherein the Cas protein is operably linked to a regulatory element, wherein when transcribed, the guide RNA comprising the guide sequence directs sequence-specific binding of a CRISPR-Cas system to a target sequence in the genomic loci of the unique gene, inducing cleavage of the genomic loci by the Cas protein, and confirming different knockout mutations in a plurality of unique genes in each cell of the population of cells thereby generating a gene knockout cell library. The invention comprehends that the population of cells is a population of eukaryotic cells, and in a preferred embodiment, the population of cells is a population of embryonic stem (ES) cells.

The one or more vectors may be plasmid vectors. The vector may be a single vector comprising Cas9, a sgRNA, and optionally, a selection marker into target cells. Not being bound by a theory, the ability to simultaneously deliver Cas9 and sgRNA through a single vector enables application to any cell type of interest, without the need to first generate cell lines that express Cas9. The regulatory element may be an inducible promoter. The inducible promoter may be a doxycycline inducible promoter. In some methods of the invention the expression of the guide sequence is under the control of the T7 promoter and is driven by the expression of T7 polymerase. The confirming of different knockout mutations may be by whole exome sequencing. The knockout mutation may be achieved in 100 or more unique genes. The knockout mutation may be achieved in 1000 or more unique genes. The knockout mutation may be achieved in 20,000 or more unique genes. The knockout mutation may be achieved in the entire genome. The knockout of gene function may be achieved in a plurality of unique genes which function in a particular physiological pathway or condition. The pathway or condition may be an immune pathway or condition. The pathway or condition may be a cell division pathway or condition.

The invention also provides kits that comprise the genome wide libraries mentioned herein. The kit may comprise a single container comprising vectors or plasmids comprising the library of the invention. The kit may also comprise a panel comprising a selection of unique CRISPR-Cas system guide RNAs comprising guide sequences from the library of the invention, wherein the selection is indicative of a particular physiological condition. The invention comprehends that the targeting is of about 100 or more sequences, about 1000 or more sequences or about 20,000 or more sequences or the entire genome. Furthermore, a panel of target sequences may be focused on a relevant or desirable pathway, such as an immune pathway or cell division.

In an additional aspect of the invention, a Cas9 enzyme may comprise one or more mutations and may be used as a generic DNA binding protein with or without fusion to a functional domain. The mutations may be artificially introduced mutations or gain- or loss-of-function mutations. The mutations may include but are not limited to mutations in one of the catalytic domains (D10 and H840) in the RuvC and HNH catalytic domains, respectively. Further mutations have been characterized. In one aspect of the invention, the functional domain may be a transcriptional activation domain, which may be VP64. In other aspects of the invention, the functional domain may be a transcriptional repressor domain, which may be KRAB or SID4X. Other aspects of the invention relate to the mutated Cas 9 enzyme being fused to domains which include but are not limited to a transcriptional activator, repressor, a recombinase, a transposase, a histone remodeler, a demethylase, a DNA methyltransferase, a cryptochrome, a light inducible/controllable domain or a chemically inducible/controllable domain. Some methods of the invention can include inducing expression of targeted genes. In one embodiment, inducing expression by targeting a plurality of target sequences in a plurality of genomic loci in a population of eukaryotic cells is by use of a functional domain.

Useful in the practice of the instant invention, reference is made to:

• • Genome-Scale CRISPR-Cas9 Knockout Screening in Human Cells. Shalem, O., Sanjana, N E., Hartenian, E., Shi, X., Scott, D A., Mikkelson, T., Heckl, D., Ebert, B L., Root, D E., Doench, J G., Zhang, F. Science December 12. (2013). [Epub ahead of print]; Published in final edited form as: Science. 2014 Jan. 3; 343(6166): 84-87.
  • Shalem et al. involves a new way to interrogate gene function on a genome-wide scale. Their studies showed that delivery of a genome-scale CRISPR-Cas9 knockout (GeCKO) library targeted 18,080 genes with 64,751 unique guide sequences enabled both negative and positive selection screening in human cells. First, the authors showed use of the GeCKO library to identify genes essential for cell viability in cancer and pluripotent stem cells. Next, in a melanoma model, the authors screened for genes whose loss is involved in resistance to vemurafenib, a therapeutic that inhibits mutant protein kinase BRAF. Their studies showed that the highest-ranking candidates included previously validated genes NF1 and MED 12 as well as novel hits NF2, CUL3, TADA2B, and TADA1. The authors observed a high level of consistency between independent guide RNAs targeting the same gene and a high rate of hit confirmation, and thus demonstrated the promise of genome-scale screening with Cas9.
    Reference is also made to US patent publication number US20140357530; and PCT Patent Publication WO2014093701, hereby incorporated herein by reference.

With respect to use of the CRISPR-Cas system generally, mention is made of the documents, including patent applications, patents, and patent publications cited throughout this disclosure as embodiments of the invention can be used as in those documents. CRISPR-Cas System(s) can be used to perform saturating or deep scanning mutagenesis of genomic loci in conjunction with a cellular phenotype—for instance, for determining critical minimal features and discrete vulnerabilities of functional elements required for gene expression, drug resistance, and reversal of disease. By saturating or deep scanning mutagenesis is meant that every or essentially every DNA base is cut within the genomic loci. A library of CRISPR-Cas guide RNAs may be introduced into a population of cells. The library may be introduced, such that each cell receives a single guide RNA (sgRNA). In the case where the library is introduced by transduction of a viral vector, as described herein, a low multiplicity of infection (MOI) is used. The library may include sgRNAs targeting every sequence upstream of a (protospacer adjacent motif) (PAM) sequence in a genomic locus. The library may include at least 100 non-overlapping genomic sequences upstream of a PAM sequence for every 1000 base pairs within the genomic locus. The library may include sgRNAs targeting sequences upstream of at least one different PAM sequence. The CRISPR-Cas System(s) may include more than one Cas protein. Any Cas protein as described herein, including orthologues or engineered Cas proteins that recognize different PAM sequences may be used. The frequency of off target sites for a sgRNA may be less than 500. Off target scores may be generated to select sgRNAs with the lowest off target sites. Any phenotype determined to be associated with cutting at a sgRNA target site may be confirmed by using sgRNA's targeting the same site in a single experiment. Validation of a target site may also be performed by using a nickase Cas9, as described herein, and two sgRNAs targeting the genomic site of interest. Not being bound by a theory, a target site is a true hit if the change in phenotype is observed in validation experiments.

The genomic loci may include at least one continuous genomic region. The at least one continuous genomic region may comprise up to the entire genome. The at least one continuous genomic region may comprise a functional element of the genome. The functional element may be within a non-coding region, coding gene, intronic region, promoter, or enhancer. The at least one continuous genomic region may comprise at least 1 kb, preferably at least 50 kb of genomic DNA. The at least one continuous genomic region may comprise a transcription factor binding site. The at least one continuous genomic region may comprise a region of DNase I hypersensitivity. The at least one continuous genomic region may comprise a transcription enhancer or repressor element. The at least one continuous genomic region may comprise a site enriched for an epigenetic signature. The at least one continuous genomic DNA region may comprise an epigenetic insulator. The at least one continuous genomic region may comprise two or more continuous genomic regions that physically interact. Genomic regions that interact may be determined by ‘4C technology’. 4C technology allows the screening of the entire genome in an unbiased manner for DNA segments that physically interact with a DNA fragment of choice, as is described in Zhao et al. ((2006) Nat Genet 38, 1341-7) and in U.S. Pat. No. 8,642,295, both incorporated herein by reference in its entirety. The epigenetic signature may be histone acetylation, histone methylation, histone ubiquitination, histone phosphorylation, DNA methylation, or a lack thereof.

CRISPR-Cas System(s) for saturating or deep scanning mutagenesis can be used in a population of cells. The CRISPR-Cas System(s) can be used in eukaryotic cells, including but not limited to mammalian and plant cells. The population of cells may be prokaryotic cells. The population of eukaryotic cells may be a population of embryonic stem (ES) cells, neuronal cells, epithelial cells, immune cells, endocrine cells, muscle cells, erythrocytes, lymphocytes, plant cells, or yeast cells.

In one aspect, the present invention provides for a method of screening for functional elements associated with a change in a phenotype. The library may be introduced into a population of cells that are adapted to contain a Cas protein. The cells may be sorted into at least two groups based on the phenotype. The phenotype may be expression of a gene, cell growth, or cell viability. The relative representation of the guide RNAs present in each group are determined, whereby genomic sites associated with the change in phenotype are determined by the representation of guide RNAs present in each group. The change in phenotype may be a change in expression of a gene of interest. The gene of interest may be upregulated, downregulated, or knocked out. The cells may be sorted into a high expression group and a low expression group. The population of cells may include a reporter construct that is used to determine the phenotype. The reporter construct may include a detectable marker. Cells may be sorted by use of the detectable marker.

In another aspect, the present invention provides for a method of screening for genomic sites associated with resistance to a chemical compound. The chemical compound may be a drug or pesticide. The library may be introduced into a population of cells that are adapted to contain a Cas protein, wherein each cell of the population contains no more than one guide RNA; the population of cells are treated with the chemical compound; and the representation of guide RNAs are determined after treatment with the chemical compound at a later time point as compared to an early time point, whereby genomic sites associated with resistance to the chemical compound are determined by enrichment of guide RNAs. Representation of sgRNAs may be determined by deep sequencing methods.

Useful in the practice of the instant invention, reference is made to the article entitled BCL11A enhancer dissection by Cas9-mediated in situ saturating mutagenesis. Canver, M. C., Smith, E. C., Sher, F., Pinello, L., Sanjana, N. E., Shalem, O., Chen, D. D., Schupp, P. G., Vinjamur, D. S., Garcia, S. P., Luc, S., Kurita, R., Nakamura, Y., Fujiwara, Y., Maeda, T., Yuan, G., Zhang, F., Orkin, S. H., & Bauer, D. E. DOI:10.1038/nature15521, published online Sep. 16, 2015, the article is herein incorporated by reference and discussed briefly below:

• • Canver et al. involves novel pooled CRISPR-Cas9 guide RNA libraries to perform in situ saturating mutagenesis of the human and mouse BCL11A erythroid enhancers previously identified as an enhancer associated with fetal hemoglobin (HbF) level and whose mouse ortholog is necessary for erythroid BCL11A expression. This approach revealed critical minimal features and discrete vulnerabilities of these enhancers. Through editing of primary human progenitors and mouse transgenesis, the authors validated the BCL11A erythroid enhancer as a target for HbF reinduction. The authors generated a detailed enhancer map that informs therapeutic genome editing.

Self-Inactivating Systems

Once all copies of a gene in the genome of a cell have been edited, continued CRISRP/Cas9 expression in that cell is no longer necessary. Indeed, sustained expression would be undesirable in case of off-target effects at unintended genomic sites, etc. Thus time-limited expression would be useful. Inducible expression offers one approach, but in addition Applicants have engineered a Self-Inactivating CRISPR-Cas9 system that relies on the use of a non-coding guide target sequence within the CRISPR vector itself. Thus, after expression begins, the CRISPR system will lead to its own destruction, but before destruction is complete it will have time to edit the genomic copies of the target gene (which, with a normal point mutation in a diploid cell, requires at most two edits). Simply, the self inactivating CRISPR-Cas system includes additional RNA (i.e., guide RNA) that targets the coding sequence for the CRISPR enzyme itself or that targets one or more non-coding guide target sequences complementary to unique sequences present in one or more of the following:

• (a) within the promoter driving expression of the non-coding RNA elements,
• (b) within the promoter driving expression of the Cas9 gene,
• (c) within 100 bp of the ATG translational start codon in the Cas9 coding sequence,
• (d) within the inverted terminal repeat (iTR) of a viral delivery vector, e.g., in the AAV genome.

Furthermore, that RNA can be delivered via a vector, e.g., a separate vector or the same vector that is encoding the CRISPR complex. When provided by a separate vector, the CRISPR RNA that targets Cas expression can be administered sequentially or simultaneously. When administered sequentially, the CRISPR RNA that targets Cas expression is to be delivered after the CRISPR RNA that is intended for e.g. gene editing or gene engineering. This period may be a period of minutes (e.g. 5 minutes, 10 minutes, 20 minutes, 30 minutes, 45 minutes, 60 minutes). This period may be a period of hours (e.g. 2 hours, 4 hours, 6 hours, 8 hours, 12 hours, 24 hours). This period may be a period of days (e.g. 2 days, 3 days, 4 days, 7 days). This period may be a period of weeks (e.g. 2 weeks, 3 weeks, 4 weeks). This period may be a period of months (e.g. 2 months, 4 months, 8 months, 12 months). This period may be a period of years (2 years, 3 years, 4 years). In this fashion, the Cas enzyme associates with a first gRNA/chiRNA capable of hybridizing to a first target, such as a genomic locus or loci of interest and undertakes the function(s) desired of the CRISPR-Cas system (e.g., gene engineering); and subsequently the Cas enzyme may then associate with the second gRNA/chiRNA capable of hybridizing to the sequence comprising at least part of the Cas or CRISPR cassette. Where the gRNA/chiRNA targets the sequences encoding expression of the Cas protein, the enzyme becomes impeded and the system becomes self inactivating. In the same manner, CRISPR RNA that targets Cas expression applied via, for example liposome, lipofection, nanoparticles, microvesicles as explained herein, may be administered sequentially or simultaneously. Similarly, self-inactivation may be used for inactivation of one or more guide RNA used to target one or more targets.

In some aspects, a single gRNA is provided that is capable of hybridization to a sequence downstream of a CRISPR enzyme start codon, whereby after a period of time there is a loss of the CRISPR enzyme expression. In some aspects, one or more gRNA(s) are provided that are capable of hybridization to one or more coding or non-coding regions of the polynucleotide encoding the CRISPR-Cas system, whereby after a period of time there is a inactivation of one or more, or in some cases all, of the CRISPR-Cas system. In some aspects of the system, and not to be limited by theory, the cell may comprise a plurality of CRISPR-Cas complexes, wherein a first subset of CRISPR complexes comprise a first chiRNA capable of targeting a genomic locus or loci to be edited, and a second subset of CRISPR complexes comprise at least one second chiRNA capable of targeting the polynucleotide encoding the CRISPR-Cas system, wherein the first subset of CRISPR-Cas complexes mediate editing of the targeted genomic locus or loci and the second subset of CRISPR complexes eventually inactivate the CRISPR-Cas system, thereby inactivating further CRISPR-Cas expression in the cell.

Thus the invention provides a CRISPR-Cas system comprising one or more vectors for delivery to a eukaryotic cell, wherein the vector(s) encode(s): (i) a CRISPR enzyme; (ii) a first guide RNA capable of hybridizing to a target sequence in the cell; (iii) a second guide RNA capable of hybridizing to one or more target sequence(s) in the vector which encodes the CRISPR enzyme; (iv) at least one tracr mate sequence; and (v) at least one tracr sequence, The first and second complexes can use the same tracr and tracr mate, thus differeing only by the guide sequence, wherein, when expressed within the cell: the first guide RNA directs sequence-specific binding of a first CRISPR complex to the target sequence in the cell; the second guide RNA directs sequence-specific binding of a second CRISPR complex to the target sequence in the vector which encodes the CRISPR enzyme; the CRISPR complexes comprise (a) a tracr mate sequence hybridised to a tracr sequence and (b) a CRISPR enzyme bound to a guide RNA, such that a guide RNA can hybridize to its target sequence; and the second CRISPR complex inactivates the CRISPR-Cas system to prevent continued expression of the CRISPR enzyme by the cell.

Further characteristics of the vector(s), the encoded enzyme, the guide sequences, etc. are disclosed elsewhere herein. For instance, one or both of the guide sequence(s) can be part of a chiRNA sequence which provides the guide, tracr mate and tracr sequences within a single RNA, such that the system can encode (i) a CRISPR enzyme; (ii) a first chiRNA comprising a sequence capable of hybridizing to a first target sequence in the cell, a first tracr mate sequence, and a first tracr sequence; (iii) a second guide RNA capable of hybridizing to the vector which encodes the CRISPR enzyme, a second tracr mate sequence, and a second tracr sequence. Similarly, the enzyme can include one or more NLS, etc.

The various coding sequences (CRISPR enzyme, guide RNAs, tracr and tracr mate) can be included on a single vector or on multiple vectors. For instance, it is possible to encode the enzyme on one vector and the various RNA sequences on another vector, or to encode the enzyme and one chiRNA on one vector, and the remaining chiRNA on another vector, or any other permutation. In general, a system using a total of one or two different vectors is preferred.

Where multiple vectors are used, it is possible to deliver them in unequal numbers, and ideally with an excess of a vector which encodes the first guide RNA relative to the second guide RNA, thereby assisting in delaying final inactivation of the CRISPR system until genome editing has had a chance to occur.

The first guide RNA can target any target sequence of interest within a genome, as described elsewhere herein. The second guide RNA targets a sequence within the vector which encodes the CRISPR Cas9 enzyme, and thereby inactivates the enzyme's expression from that vector. Thus the target sequence in the vector must be capable of inactivating expression. Suitable target sequences can be, for instance, near to or within the translational start codon for the Cas9 coding sequence, in a non-coding sequence in the promoter driving expression of the non-coding RNA elements, within the promoter driving expression of the Cas9 gene, within 100bp of the ATG translational start codon in the Cas9 coding sequence, and/or within the inverted terminal repeat (iTR) of a viral delivery vector, e.g., in the AAV genome. A double stranded break near this region can induce a frame shift in the Cas9 coding sequence, causing a loss of protein expression. An alternative target sequence for the “self-inactivating” guide RNA would aim to edit/inactivate regulatory regions/sequences needed for the expression of the CRISPR-Cas9 system or for the stability of the vector. For instance, if the promoter for the Cas9 coding sequence is disrupted then transcription can be inhibited or prevented. Similarly, if a vector includes sequences for replication, maintenance or stability then it is possible to target these. For instance, in a AAV vector a useful target sequence is within the iTR. Other useful sequences to target can be promoter sequences, polyadenlyation sites, etc.

Furthermore, if the guide RNAs are expressed in array format, the “self-inactivating” guide RNAs that target both promoters simultaneously will result in the excision of the intervening nucleotides from within the CRISPR-Cas expression construct, effectively leading to its complete inactivation. Similarly, excision of the intervening nucleotides will result where the guide RNAs target both ITRs, or targets two or more other CRISPR-Cas components simultaneously. Self-inactivation as explained herein is applicable, in general, with CRISPR-Cas9 systems in order to provide regulation of the CRISPR-Cas9. For example, self-inactivation as explained herein may be applied to the CRISPR repair of mutations, for example expansion disorders, as explained herein. As a result of this self-inactivation, CRISPR repair is only transiently active.

Addition of non-targeting nucleotides to the 5′ end (e.g. 1-10 nucleotides, preferably 1-5 nucleotides) of the “self-inactivating” guide RNA can be used to delay its processing and/or modify its efficiency as a means of ensuring editing at the targeted genomic locus prior to CRISPR-Cas9 shutdown.

In one aspect of the self-inactivating AAV-CRISPR-Cas9 system, plasmids that co-express one or more sgRNA targeting genomic sequences of interest (e.g. 1-2, 1-5, 1-10, 1-15, 1-20, 1-30) may be established with “self-inactivating” sgRNAs that target an SpCas9 sequence at or near the engineered ATG start site (e.g. within 5 nucleotides, within 15 nucleotides, within 30 nucleotides, within 50 nucleotides, within 100 nucleotides). A regulatory sequence in the U6 promoter region can also be targeted with an sgRNA. The U6-driven sgRNAs may be designed in an array format such that multiple sgRNA sequences can be simultaneously released. When first delivered into target tissue/cells (left cell) sgRNAs begin to accumulate while Cas9 levels rise in the nucleus. Cas9 complexes with all of the sgRNAs to mediate genome editing and self-inactivation of the CRISPR-Cas9 plasmids.

One aspect of a self-inactivating CRISPR-Cas9 system is expression of singly or in tandam array format from 1 up to 4 or more different guide sequences; e.g. up to about 20 or about 30 guides sequences. Each individual self inactivating guide sequence may target a different target. Such may be processed from, e.g. one chimeric pol3 transcript. Pol3 promoters such as U6 or H1 promoters may be used. Pol2 promoters such as those mentioned throughout herein. Inverted terminal repeat (iTR) sequences may flank the Pol3 promoter—sgRNA(s)-Pol2 promoter-Cas9.

One aspect of a chimeric, tandem array transcript is that one or more guide(s) edit the one or more target(s) while one or more self inactivating guides inactivate the CRISPR/Cas9 system. Thus, for example, the described CRISPR-Cas9 system for repairing expansion disorders may be directly combined with the self-inactivating CRISPR-Cas9 system described herein. Such a system may, for example, have two guides directed to the target region for repair as well as at least a third guide directed to self-inactivation of the CRISPR-Cas9. Reference is made to Application Ser. No. PCT/US2014/069897, entitled “Compositions And Methods Of Use Of Crispr-Cas Systems In Nucleotide Repeat Disorders,” published Dec. 12, 2014 as WO/2015/089351.

One type of programmable DNA-binding domain is provided by artificial zinc-finger (ZF) technology, which involves arrays of ZF modules to target new DNA-binding sites in the genome. Each finger module in a ZF array targets three DNA bases. A customized array of individual zinc finger domains is assembled into a ZF protein (ZFP).

ZFPs can comprise a functional domain. The first synthetic zinc finger nucleases (ZFNs) were developed by fusing a ZF protein to the catalytic domain of the Type IIS restriction enzyme FokI. (Kim, Y. G. et al., 1994, Chimeric restriction endonuclease, Proc. Natl. Acad. Sci. U.S.A. 91, 883-887; Kim, Y. G. et al., 1996, Hybrid restriction enzymes: zinc finger fusions to Fok I cleavage domain. Proc. Natl. Acad. Sci. U.S.A. 93, 1156-1160). Increased cleavage specificity can be attained with decreased off target activity by use of paired ZFN heterodimers, each targeting different nucleotide sequences separated by a short spacer. (Doyon, Y. et al., 2011, Enhancing zinc-finger-nuclease activity with improved obligate heterodimeric architectures. Nat. Methods 8, 74-79). ZFPs can also be designed as transcription activators and repressors and have been used to target many genes in a wide variety of organisms.

In advantageous embodiments of the invention, the methods provided herein use isolated, non-naturally occurring, recombinant or engineered DNA binding proteins that comprise TALE monomers or TALE monomers or half monomers as a part of their organizational structure that enable the targeting of nucleic acid sequences with improved efficiency and expanded specificity.

Naturally occurring TALEs or “wild type TALEs” are nucleic acid binding proteins secreted by numerous species of proteobacteria. TALE polypeptides contain a nucleic acid binding domain composed of tandem repeats of highly conserved monomer polypeptides that are predominantly 33, 34 or 35 amino acids in length and that differ from each other mainly in amino acid positions 12 and 13. In advantageous embodiments the nucleic acid is DNA. As used herein, the term “polypeptide monomers”, “TALE monomers” or “monomers” will be used to refer to the highly conserved repetitive polypeptide sequences within the TALE nucleic acid binding domain and the term “repeat variable di-residues” or “RVD” will be used to refer to the highly variable amino acids at positions 12 and 13 of the polypeptide monomers. As provided throughout the disclosure, the amino acid residues of the RVD are depicted using the IUPAC single letter code for amino acids. A general representation of a TALE monomer which is comprised within the DNA binding domain is X1-11-(X12X13)-X14-33 or 34 or 35, where the subscript indicates the amino acid position and X represents any amino acid. X12X13 indicate the RVDs. In some polypeptide monomers, the variable amino acid at position 13 is missing or absent and in such monomers, the RVD consists of a single amino acid. In such cases the RVD may be alternatively represented as X*, where X represents X12 and (*) indicates that X13 is absent. The DNA binding domain comprises several repeats of TALE monomers and this may be represented as (X1-11-(X12X13)-X14-33 or 34 or 35)z, where in an advantageous embodiment, z is at least 5 to 40. In a further advantageous embodiment, z is at least 10 to 26.

The TALE monomers have a nucleotide binding affinity that is determined by the identity of the amino acids in its RVD. For example, polypeptide monomers with an RVD of NI preferentially bind to adenine (A), monomers with an RVD of NG preferentially bind to thymine (T), monomers with an RVD of HD preferentially bind to cytosine (C) and monomers with an RVD of NN preferentially bind to both adenine (A) and guanine (G). In yet another embodiment of the invention, monomers with an RVD of IG preferentially bind to T. Thus, the number and order of the polypeptide monomer repeats in the nucleic acid binding domain of a TALE determines its nucleic acid target specificity. In still further embodiments of the invention, monomers with an RVD of NS recognize all four base pairs and may bind to A, T, G or C. The structure and function of TALEs is further described in, for example, Moscou et al., Science 326:1501 (2009); Boch et al., Science 326:1509-1512 (2009); and Zhang et al., Nature Biotechnology 29:149-153 (2011), each of which is incorporated by reference in its entirety.

The polypeptides used in methods of the invention are isolated, non-naturally occurring, recombinant or engineered nucleic acid-binding proteins that have nucleic acid or DNA binding regions containing polypeptide monomer repeats that are designed to target specific nucleic acid sequences.

As described herein, polypeptide monomers having an RVD of HN or NH preferentially bind to guanine and thereby allow the generation of TALE polypeptides with high binding specificity for guanine containing target nucleic acid sequences. In a preferred embodiment of the invention, polypeptide monomers having RVDs RN, NN, NK, SN, NH, KN, HN, NQ, HH, RG, KH, RH and SS preferentially bind to guanine. In a much more advantageous embodiment of the invention, polypeptide monomers having RVDs RN, NK, NQ, HH, KH, RH, SS and SN preferentially bind to guanine and thereby allow the generation of TALE polypeptides with high binding specificity for guanine containing target nucleic acid sequences. In an even more advantageous embodiment of the invention, polypeptide monomers having RVDs HH, KH, NH, NK, NQ, RH, RN and SS preferentially bind to guanine and thereby allow the generation of TALE polypeptides with high binding specificity for guanine containing target nucleic acid sequences. In a further advantageous embodiment, the RVDs that have high binding specificity for guanine are RN, NH RH and KH. Furthermore, polypeptide monomers having an RVD of NV preferentially bind to adenine and guanine. In more preferred embodiments of the invention, monomers having RVDs of H*, HA, KA, N*, NA, NC, NS, RA, and S* bind to adenine, guanine, cytosine and thymine with comparable affinity.

The predetermined N-terminal to C-terminal order of the one or more polypeptide monomers of the nucleic acid or DNA binding domain determines the corresponding predetermined target nucleic acid sequence to which the polypeptides of the invention will bind. As used herein the monomers and at least one or more half monomers are “specifically ordered to target” the genomic locus or gene of interest. In plant genomes, the natural TALE-binding sites always begin with a thymine (T), which may be specified by a cryptic signal within the non-repetitive N-terminus of the TALE polypeptide; in some cases this region may be referred to as repeat 0. In animal genomes, TALE binding sites do not necessarily have to begin with a thymine (T) and polypeptides of the invention may target DNA sequences that begin with T, A, G or C. The tandem repeat of TALE monomers always ends with a half-length repeat or a stretch of sequence that may share identity with only the first 20 amino acids of a repetitive full length TALE monomer and this half repeat may be referred to as a half-monomer (FIG. 8). Therefore, it follows that the length of the nucleic acid or DNA being targeted is equal to the number of full monomers plus two.

As described in Zhang et al., Nature Biotechnology 29:149-153 (2011), TALE polypeptide binding efficiency may be increased by including amino acid sequences from the “capping regions” that are directly N-terminal or C-terminal of the DNA binding region of naturally occurring TALEs into the engineered TALEs at positions N-terminal or C-terminal of the engineered TALE DNA binding region. Thus, in certain embodiments, the TALE polypeptides described herein further comprise an N-terminal capping region and/or a C-terminal capping region.

An exemplary amino acid sequence of a N-terminal capping region is:

(SEQ ID NO: 18)
M D P I R S R T P S P A R E L L S G P Q P D G V Q

P T A D R G V S P P A G G P L D G L P A R R T M S

R T R L P S P P A P S P A F S A D S F S D L L R Q

F D P S L F N T S L F D S L P P F G A H H T E A A

T G E W D E V Q S G L R A A D A P P P T M R V A V

T A A R P P R A K P A P R R R A A Q P S D A S P A

A Q V D L R T L G Y S Q Q Q Q E K I K P K V R S T

V A Q H H E A L V G H G F T H A H I V A L S Q H P

A A L G T V A V K Y Q D M I A A L P E A T H E A I

V G V G K Q W S G A R A L E A L L T V A G E L R G

P P L Q L D T G Q L L K I A K R G G V T A V E A V

H A W R N A L T G A P L N

An exemplary amino acid sequence of a C-terminal capping region is:

(SEQ ID NO: 19)
R P A L E S I V A Q L S R P D P A L A A L T N D H

L V A L A C L G G R P A L D A V K K G L P H A P A

L I K R T N R R I P E R T S H R V A D H A Q V V R

V L G F F Q C H S H P A Q A F D D A M T Q F G M S

R H G L L Q L F R R V G V T E L E A R S G T L P P

A S Q R W D R I L Q A S G M K R A K P S P T S T Q

T P D Q A S L H A F A D S L E R D L D A P S P M H

E G D Q T R A S

As used herein the predetermined “N-terminus” to “C terminus” orientation of the N-terminal capping region, the DNA binding domain comprising the repeat TALE monomers and the C-terminal capping region provide structural basis for the organization of different domains in the d-TALEs or polypeptides of the invention.

The entire N-terminal and/or C-terminal capping regions are not necessary to enhance the binding activity of the DNA binding region. Therefore, in certain embodiments, fragments of the N-terminal and/or C-terminal capping regions are included in the TALE polypeptides described herein.

In certain embodiments, the TALE polypeptides described herein contain a N-terminal capping region fragment that included at least 10, 20, 30, 40, 50, 54, 60, 70, 80, 87, 90, 94, 100, 102, 110, 117, 120, 130, 140, 147, 150, 160, 170, 180, 190, 200, 210, 220, 230, 240, 250, 260 or 270 amino acids of an N-terminal capping region. In certain embodiments, the N-terminal capping region fragment amino acids are of the C-terminus (the DNA-binding region proximal end) of an N-terminal capping region. As described in Zhang et al., Nature Biotechnology 29:149-153 (2011), N-terminal capping region fragments that include the C-terminal 240 amino acids enhance binding activity equal to the full length capping region, while fragments that include the C-terminal 147 amino acids retain greater than 80% of the efficacy of the full length capping region, and fragments that include the C-terminal 117 amino acids retain greater than 50% of the activity of the full-length capping region.

In some embodiments, the TALE polypeptides described herein contain a C-terminal capping region fragment that included at least 6, 10, 20, 30, 37, 40, 50, 60, 68, 70, 80, 90, 100, 110, 120, 127, 130, 140, 150, 155, 160, 170, 180 amino acids of a C-terminal capping region. In certain embodiments, the C-terminal capping region fragment amino acids are of the N-terminus (the DNA-binding region proximal end) of a C-terminal capping region. As described in Zhang et al., Nature Biotechnology 29:149-153 (2011), C-terminal capping region fragments that include the C-terminal 68 amino acids enhance binding activity equal to the full length capping region, while fragments that include the C-terminal 20 amino acids retain greater than 50% of the efficacy of the full length capping region.

In certain embodiments, the capping regions of the TALE polypeptides described herein do not need to have identical sequences to the capping region sequences provided herein. Thus, in some embodiments, the capping region of the TALE polypeptides described herein have sequences that are at least 50%, 60%, 70%, 80%, 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98% or 99% identical or share identity to the capping region amino acid sequences provided herein. Sequence identity is related to sequence homology. Homology comparisons may be conducted by eye, or more usually, with the aid of readily available sequence comparison programs. These commercially available computer programs may calculate percent (%) homology between two or more sequences and may also calculate the sequence identity shared by two or more amino acid or nucleic acid sequences. In some preferred embodiments, the capping region of the TALE polypeptides described herein have sequences that are at least 95% identical or share identity to the capping region amino acid sequences provided herein.

Sequence homologies may be generated by any of a number of computer programs known in the art, which include but are not limited to BLAST or FASTA. Suitable computer program for carrying out alignments like the GCG Wisconsin Bestfit package may also be used. Once the software has produced an optimal alignment, it is possible to calculate % homology, preferably % sequence identity. The software typically does this as part of the sequence comparison and generates a numerical result.

In advantageous embodiments described herein, the TALE polypeptides of the invention include a nucleic acid binding domain linked to the one or more effector domains. The terms “effector domain” or “regulatory and functional domain” refer to a polypeptide sequence that has an activity other than binding to the nucleic acid sequence recognized by the nucleic acid binding domain. By combining a nucleic acid binding domain with one or more effector domains, the polypeptides of the invention may be used to target the one or more functions or activities mediated by the effector domain to a particular target DNA sequence to which the nucleic acid binding domain specifically binds.

In some embodiments of the TALE polypeptides described herein, the activity mediated by the effector domain is a biological activity. For example, in some embodiments the effector domain is a transcriptional inhibitor (i.e., a repressor domain), such as an mSin interaction domain (SID). SID4X domain or a Kruppel-associated box (KRAB) or fragments of the KRAB domain. In some embodiments the effector domain is an enhancer of transcription (i.e. an activation domain), such as the VP16, VP64 or p65 activation domain. In some embodiments, the nucleic acid binding is linked, for example, with an effector domain that includes but is not limited to a transposase, integrase, recombinase, resolvase, invertase, protease, DNA methyltransferase, DNA demethylase, histone acetylase, histone deacetylase, nuclease, transcriptional repressor, transcriptional activator, transcription factor recruiting, protein nuclear-localization signal or cellular uptake signal.

In some embodiments, the effector domain is a protein domain which exhibits activities which include but are not limited to transposase activity, integrase activity, recombinase activity, resolvase activity, invertase activity, protease activity, DNA methyltransferase activity, DNA demethylase activity, histone acetylase activity, histone deacetylase activity, nuclease activity, nuclear-localization signaling activity, transcriptional repressor activity, transcriptional activator activity, transcription factor recruiting activity, or cellular uptake signaling activity. Other preferred embodiments of the invention may include any combination the activities described herein.

Although the present invention and its advantages have been described in detail, it should be understood that various changes, substitutions and alterations can be made herein without departing from the spirit and scope of the invention as defined in the appended claims.

The present invention will be further illustrated in the following Examples which are given for illustration purposes only and are not intended to limit the invention in any way.

Brief description of the tables

Table 1. Sample information, including Cas9 activity data for each cell line using reporter assay.

Table 2. List of positive control genes and sgRNAs.

The present invention will be further illustrated in the following Examples which are given for illustration purposes only and are not intended to limit the invention in any way.

TABLE 1
							Cas9
Name	Alias	Type	Subtype	Primary Tissue	Culture medium	Pathology	activity
A375_SKIN	A375	Melanoma		skin	DMEM; 10% FBS	primary	90.4
A673_BONE	A673	Bone sarcoma	Ewings	bone	DMEM; 10% FBS	primary	67.2
BT12_SOFT_TISSUE	BT12	Rhabdoid		central_nervous_	DMEM; 10% FBS		78.7
				system
BT16_SOFT_TISSUE	BT16	Rhabdoid		central_nervous_	DMEM; 10% FBS		47.7
				system
BXPC3_PANCREAS	BXPC3	Pancreas	Pancreas ductal	pancreas	RPMI; 10% FBS	primary	81.6
			carcinoma
CADOESl_BONE	CADOES1	Bone sarcoma	Ewings	bone	RPMI; 10% FBS	metastasis	97.8
CAL120_BREAST	CAL120	Breast	Breast	breast	DMEM; 10% FBS	metastasis	80.2
			carcinoma
COLO699_LUNG	COLO699	Lung NSCLC	Lung	lung	RPMI; 10% FBS	metastasis	61.8
			adenocarcinoma
COLO741_SKIN	COLO741	Melanoma	Carcinoma	skin	RPMI; 10% FBS	primary	82.6
CORL105_LUNG	CORL105	Lung NSCLC	Lung	lung	RPMI; 10% FBS	primary	84.7
			adenocarcinoma
EW8_BONE	EW8	Bone sarcoma	Ewings	bone	DMEM; 10% FBS;		56.8
					2 mM L-glutamine
EWS502_BONE	EW5502	Bone sarcoma	Ewings	bone	RPMI; 15% FBS;		84.3
					2 mM glutamine
G402_SOFT_TISSUE	G402	Soft Tissue	Rhabdoid	kidney	McCoy's 5A; 10% FBS	primary	81.1
		Sarcoma
HCC44_LUNG	HCC44	Lung NSCLC		lung	RPMI; 10% FBS	primary	93.3
HS294T_SKIN	HS294T	Melanoma		skin	DMEM; 10% FBS	metastasis	82.2
HT29_LARGE_	HT29	Colon	Colon	large_intestine	McCoy's 5A; 10% FBS	primary	85.2
INTESTINE			adenocarcinoma
K562_	K562	Leukemia	CML-BC	haematopoietic_	IMDM; 10% FBS	metastasis	46.8
HAEMATOPOIETIC_			myeloid	and_lymphoid_
AND_LYMPHOID_				tissue
TISSUE
KD_SOFT_TISSUE	KD	Rhabdoid	Rhabdoid_		R10		39.5
			tumour
L33_PANCREAS	L33	Pancreas	Pancreas	pancreas	DMEM 10% FBS;	primary	48.1
			carcinoma		1 mM Sodium pyruvate;
					1 mM NEAA;
					2 mM glutamine
LNCAPCLONEFGC_	LNCAPCLONEFGC	Prostate	Prostate	prostate	RPMI; 10% Serum	metastasis	88.8
PROSTATE			adenocarcinoma
MEWO_SKIN	MEWO	Melanoma		skin	RPMI; 10% FBS;	metastasis	85.6
					2 mM glutamine
MHHES1_BONE	MHHES1	Bone sarcoma	Ewings	bone	R10		61.4
MON_SOFT_TISSUE	MON	Rhabdoid	Rhabdoid_		R10		74.2
			tumour
NCIH1373_LUNG	NCIH1373	Lung NSCLC	Lung	lung	RPMI; 10% FBS	primary	86.7
			adenocarcinoma
NCIH2004RT_SOFT_	NCIH2004RT	Rhabdoid			RPMI; 10% FBS		39.9
TISSUE
NCIH2009_LUNG	NCIH2009	Lung NSCLC	Lung	lung	DMEM:F12 (1:1);	metastasis	89.7
			adenocarcinoma		5% FBS; 0.005 mg/ml
					Insulin; 0.01 mg/ml
					transferrin; 30 nM
					sodium selenite; 10 nM
					hydrocortisone; 10 nM
					beta estradiol; 10 nM
					HEPES; 2 mM
					L-glutamine
PANC0327_	PANC0327	Pancreas	Pancreas ductal	pancreas	RPMI; 15% FBS;	primary	85.2
PANCREAS			carcinoma		0.1 unit/ml human
					insulin
PANC0813_	PANC0813	Pancreas	Pancreas ductal	pancreas	RPMI; 15% FBS; 2 mM	primary	88.3
PANCREAS			carcinoma		Glutamine; 1.5 g/L
					Sodium bicarbonate;
					4.5 g/L glucose; 10 mM
					HEPES; 1 mM Sodium
					Pyruvate; 10 units/mL
					Insulin
PANC1_PANCREAS	PANC1	Pancreas	Pancreas ductal	pancreas	DMEM; 10% FBS	primary	80
			carcinoma
PATU8902T_	PATU8902T	Pancreas	Pancreas ductal	pancreas	DMEM; 10% FBS		93
PANCREAS			carcinoma
PATU8988T_	PATU8988T	Pancreas	Pancreas ductal	pancreas			80
PANCREAS			carcinoma
PC3_PROSTATE	PC3	Prostate	Prostate	prostate	HamsF12; 10% FBS	metastasis	58.4
			adenocarcinoma
RDES_BONE	RDES	Bone sarcoma	Ewings	bone	R10	primary	88.3
SKES1_BONE	SKES1	Bone sarcoma	Ewings	bone	McCoy 5A: 15% FBS		58
SKNEP1_BONE	SKNEP1	Bone sarcoma	Ewings	bone	D20 + 1% glutamine		56.8
SKPNDW_BONE	SKPNDW	Bone sarcoma	Ewings	bone	D10 + 1% glutamine		68.8
SU8686_PANCREAS	SU8686	Pancreas	Pancreas ductal	pancreas	RPMI; 10% FBS	primary	89.8
			carcinoma
T47D_BREAST	T47D	Breast	Breast ductal	breast	RPMI; 10% FBS,	metastasis	68
			carcinoma		2 u/ml Human Insulin
TC32_BONE	TC32	Bone sarcoma	Ewings	bone	RPMI; 10% FBS;		57.7
					2 mM glutamine
TC71_BONE	TC71	Bone sarcoma	Ewings	bone	IMDM; 10% FBS	primary	57.4
TOV112D_OVARY	TOV112D	Ovarian	Endometrioid	ovary	MCDB 105:Medium	primary	47.6
			carcinoma		199 (1:1); 15% FBS;
					1.5 g/L NaHCO3
TTC549 SOFT_	TTC549	Rhabdoid	Rhabdoid_	R10			70.8
TISSUE			tumour
TTC709 SOFT_	TTC709	Soft Tissue	Rhabdoid	soft_tissue	RPMI; 10% FBS		48.8
TISSUE		Sarcoma

TABLE 2
SEQ
ID
NO:	Name	Description
20	AAGCGGCACCCAGCGCGATA	CDC5L
21	AAGCGGCAGCTCCCTTTCCG	CDC5L
22	AAGCGGCGGTCCTCGCTGGA	CDC5L
23	AAGCGGCTCACTGTGCGCCG	CDC5L
24	AAGCGGCTCATCTCGCAGTG	CDC5L
25	AAGCGGGAGAATCTGGGGCG	CDC5L
26	ACACACCCGTGGTCACGTCA	DDX5
27	ACACACCCGTTGTGTCATGA	DDX5
28	ACACACCTCCGACTTCCGCA	DDX5
29	ACACACCTGTCTGTTAGGTC	DDX5
30	ACACACCTGTGCGTTTCCGT	DDX5
31	ACACACCTTCCTCCCCGTAG	DDX5
32	ACACACTCGATGTCACTCCA	DHX8
33	ACACACTGAAGGCAAGTAGC	DHX8
34	ACACACTGCCACTCCTCAGA	DHX8
35	ACACAGCGCCGCTTACTCCG	DHX15
36	ACACAGCGTCTCTGCCACCC	DHX15
37	ACACAGCTATGGAATACCGC	DHX15
38	ACACAGCTCACCCCCATGGG	DHX15
39	ACCATTACTCTTACTCTCGA	FAU
40	ACCATTATCACCTGAGCTAA	FAU
41	ACCATTATTATCCTGCCATC	FAU
42	ACTGGCTGCGATATGTGAAT	HNRNPA1
43	ACTGGCTGTCAGAGTGTGCA	HNRNPA1
44	ACTGGCTGTCTTCCACGCAC	HNRNPA1
45	ACTGGCTGTGACACTCCTGA	HNRNPA1
46	ACTGGCTTACCTCCCACTGC	HNRNPA1
47	ACTGGGATTGTAGAGAGCAT	HNRNPC
48	ACTGGGATTTCTGCGCCATC	HNRNPC
49	ACTGGGCCAAGGTGGGCCAG	HNRNPC
50	ACTGGGCCACTCAGAGCAGA	HNRNPC
51	ACTGGGCTAACCTAAAGCTG	HNRNPC
52	ACTGGGCTATATTTGTCATA	HNRNPC
53	ACTGGTTGCCAAACTCCTCC	HNRNPK
54	ACTGGTTGCTCAAATGAAGC	HNRNPK
55	ACTGGTTTATCATTCTCTGC	HNRNPK
56	ACTGGTTTCCACACTCTGTG	HNRNPK
57	ACTGGTTTCCATATTCAAGC	HNRNPK
58	ACTGGTTTCTCATTCGAACC	HNRNPK
59	ACTGTAACTCTGCTGTCCGT	HNRNPU
60	ACTGTAAGATTTGCTAACTG	HNRNPU
61	ACTGTAATAAATTTATGAAC	HNRNPU
62	ACTGTACACCGCGCCGTCCT	HNRNPU
63	ACTGTACACGGTGATGTTAG	HNRNPU
64	ACTTCGCTAGAGCTATTGTT	HSPA1A
65	ACTTCGGAGGGCGCCACCAC	HSPA1A
66	ACTTCGGCATTTCATCGATG	HSPA1A
67	ACTTCGGCCTCGCCCGCGAG	HSPA1A
68	ACTTCGGCGAATGGAGCATT	HSPA1A
69	ACTTCGGCTATGACCTGTAC	HSPA1A
70	ACTTCGGGCGCCGCAACAGC	HSPA1B
71	ACTTCGGGGGAATCTCGTCC	HSPA1B
72	ACTTCGTATATCAGCAACTA	HSPA1B
73	ACTTCGTATGTTTACAAGAA	HSPA1B
74	ACTTCGTATTTGCCTAATGA	HSPA1B
75	ACTTCGTCCTGTGTTGTAGC	HSPA1B
76	ACTTCGTCTACGATGCTGTG	HSPA1L
77	ACTTCGTGCGGGACATGCCG	HSPA1L
78	ACTTCGTTTGTTCACTGTTG	HSPA1L
79	ACTTCTAATCTGTTTCACAA	HSPA1L
80	ACTTCTAATGTCCTAATCAT	HSPA1L
81	ACTTCTACAAGCAGTATCCA	HSPA1L
82	ACTTCTACACTATTAAAAGC	HSPA2
83	ACTTCTACATCAACTATTAC	HSPA2
84	ACTTCTACTGTCTTAATAGA	HSPA2
85	ACTTCTAGCAAGAGAGTTGC	HSPA2
86	ACTTCTATCACAGACCTATC	HSPA2
87	ACTTCTATCATACTCAGAGT	HSPA2
88	ACTTCTCGTGCTTCCGCCGG	HSPA6
89	ACTTCTCTCCGCGTACATGC	HSPA6
90	ACTTCTCTCCGCTCGGAAGG	HSPA6
91	ACTTCTCTTCCTCCCGCCAG	HSPA6
92	ACTTCTGAAATCGTCGTTGA	HSPA6
93	ACTTCTGAGTGATGTTCCCC	HSPA6
94	ACTTCTGCAAGGACTTTGTC	HSPA8
95	ACTTCTGCAGAGCTACCTAA	HSPA8
96	ACTTCTGCAGTACGAGAACG	HSPA8
97	ACTTCTGCAGTCGGCAGTGT	HSPA8
98	ACTTCTGCATCCGGTGCAAG	HSPA8
99	ACTTCTGCCTGCGCGATCGC	HSPA8
100	AGAACAGACTCCCTCATGCA	IFNG
101	AGAACAGACTCCGCAGATCT	IFNG
102	AGAACAGCAATGCAATCTGT	IFNG
103	AGAACAGCTGCAGTTCCGAA	IFNG
104	AGAACAGCTTCAAACAGAAC	IFNG
105	AGAACAGCTTCAAGAGACTC	IFNG
106	AGATGATGTCATGACTCGGC	RPSA
107	AGATGATGTCGTTTGATACC	RPSA
108	AGATGATGTCTTGCTCCCAC	RPSA
109	AGATGATGTCTTTAATGAAA	RPSA
110	AGATGATTCAGATGAAGAAG	RPSA
111	AGCATTGTAGAATGATACGT	MAGOH
112	AGCATTGTCATCGTCACCTC	MAGOH
113	AGCATTTCCAGGGGAAGCGT	MAGOH
114	AGCATTTCGTCCACGTCTAG	MAGOH
115	AGCTTTGTACTTATGCTCCT	HNRNPM
116	AGCTTTGTATACGCTGCCAT	HNRNPM
117	AGCTTTGTCAAGATGTTCCC	HNRNPM
118	AGCTTTGTCAGAATAAACTC	HNRNPM
119	AGCTTTGTCCCTTGAAGTAG	HNRNPM
120	AGCTTTGTCTCTTATTGCTA	HNRNPM
121	AGGAAGCGATGGCGGAGGAG	NCBP1
122	AGGAAGCGGAGCGGATTCGC	NCBP1
123	AGGAAGCTGGTTTCATATGG	NCBP1
124	AGGAAGGACTGCTCTGCACC	NCBP1
125	AGGAAGGAGACAGGCAGTTC	NCBP1
126	AGGAAGGATTTCAGAAATAC	NCBP1
127	AGGAGTAGCTGATCAAACCA	RPL10A
128	AGGAGTAGGGTTAACGGTTT	RPL10A
129	AGGAGTAGTAAAACTCCTGC	RPL10A
130	AGGAGTATTCTCCATCAATA	RPL10A
131	AGGAGTCATCCTGCTCCGAG	RPL10A
132	AGGAGTCCCATATAATCACC	RPL10A
133	ATATCTTCAGTCAATTGAGA	PRPS2
134	ATATCTTCCAATAGCAAACG	PRPS2
135	ATATCTTCCGACGTAGCTTT	PRPS2
136	ATATCTTGCACAACAGAAAC	PRPS2
137	ATATCTTTCCTGCAGCCCCC	PRPS2
138	ATATCTTTGATGAAGGGAAG	PRPS2
139	ATCAAAAGGAGCGGGGTCGA	PSMA1
140	ATCAAAAGTGGCTCCGGCCG	PSMA1
141	ATCAAAATGCTGCAGAATCG	PSMA1
142	ATCAAACACATCCCGATTGC	PSMA1
143	ATCAAACACATTTGTGCGAC	PSMA1
144	ATCAAACACGTAACCATAGA	PSMA1
145	ATCAAACAGAGGCCGCATGC	PSMA2
146	ATCAAACATGTCACAAGAGT	PSMA2
147	ATCAAACCAGATGTTACAAT	PSMA2
148	ATCAAACCCATAACTTCCAT	PSMA2
149	ATCAAACTAAGTCTTAAACA	PSMA2
150	ATCAAACTGCATGTACCACT	PSMA3
151	ATCAAACTTTGAGTCACGTC	PSMA3
152	ATCAAAGCCCTCGGGCACGT	PSMA3
153	ATCAAAGCCCTTAGACGTCG	PSMA3
154	ATCAAAGCGCTAACCAACCA	PSMA3
155	ATCAAAGCGGCCGATCCTTG	PSMA3
156	ATCAAAGCTGTCCCGATTGT	PSMA4
157	ATCAAAGCTTCTTGCTTGTC	PSMA4
158	ATCAAAGGAGTTTGCTGCAA	PSMA4
159	ATCAAAGGATTCCCCCTTTG	PSMA4
160	ATCAAAGTGAACGGAAAAGC	PSMA4
161	ATCAAAGTGTCTGACTTATT	PSMA4
162	ATCAAATACAAGCCCCGAGA	PSMA5
163	ATCAAATCCAGTGTGACGCC	PSMA5
164	ATCAAATGACGGGTGAAGCC	PSMA5
165	ATCAAATGCTCGAGTCAGAA	PSMA5
166	ATCAAATGGTCATGCCTCTA	PSMA5
167	ATCAAATGTTAGAGTAGCTG	PSMA5
168	ATCAACAACCAAATCTGTAC	PSMA6
169	ATCAACAATACCCGCCAACT	PSMA6
170	ATCAACAATACCTCGATAGA	PSMA6
171	ATCAACACCTATGAAGACAA	PSMA6
172	ATCAACACTGCAAGCTGTGC	PSMA7
173	ATCAACAGGTCCTTCTCATG	PSMA7
174	ATCAACATATTCCATTTAAC	PSMA7
175	ATCAACATCAGTAGCATCGT	PSMA7
176	ATCAACATCTATACTTACGA	PSMA7
177	ATCAACATTTGCTCCAACGA	PSMA7
178	ATCAACCATCAGAAATGCAT	PSMB1
179	ATCAACCTCTGCTGATCAGA	PSMB1
180	ATCAACCTTGGCATCAGCTA	PSMB1
181	ATCAACGAGCAGACAAACGA	PSMB1
182	ATCAACGCCCTCCAAGACTA	PSMB1
183	ATCAACGTGTTCCTGCTATC	PSMB1
184	ATCAACTCCACGGATCCCGC	PSMB2
185	ATCAACTCCGGCTTAGGGAC	PSMB2
186	ATCAACTCTCCTCCAGTCAT	PSMB2
187	ATCAACTCTGCATTCGCCGC	PSMB2
188	ATCAACTGCGATGTCAAAGC	PSMB2
189	ATCAACTGTATGTCTTGACC	PSMB3
190	ATCAACTTGCCAGCCCCAAA	PSMB3
191	ATCAACTTTCCGGACAAATA	PSMB3
192	ATCAACTTTGTAGTTGACGC	PSMB3
193	ATCAAGAATCAGTTTACAGA	PSMB3
194	ATCAAGAATCTTGTCCCCTG	PSMB3
195	ATCAAGACCATTGACGCCCA	PSMB4
196	ATCAAGACCCTGGAGCACCG	PSMB4
197	ATCAAGACCTGCTAATTTCA	PSMB4
198	ATCAAGAGCGACAGCACCAC	PSMB4
199	ATCAAGATAGATATTATAGC	PSMB5
200	ATCAAGCAGAAACTCCACGA	PSMB5
201	ATCAAGCATGATTCTAACAT	PSMB5
202	ATCAAGCCGGGAAGCTCCTT	PSMB5
203	ATCAAGCCTTGCGTGATGTG	PSMB5
204	ATCAAGCTCACGTTCATAAA	PSMB5
205	ATCAAGCTTCGTAATGAGTA	PSMB6
206	ATCAAGGACATCTCTCTTGA	PSMB6
207	ATCAAGGAGAACGACCCCTC	PSMB6
208	ATCAAGGAGATATGGTCGAC	PSMB6
209	ATCAAGGATAGACCTTGACA	PSMB6
210	ATCAAGGCCCAAGTGCTCAG	PSMB6
211	ATCAAGGCTGAAGCATAGCC	PSMB7
212	ATCAAGGGGATCATCCAAGA	PSMB7
213	ATCAAGTAATTCTGCTAAGA	PSMB7
214	ATCAAGTACATGGGGCCGGC	PSMB7
215	ATCAAGTCACCGCAGACCAA	PSMB7
216	ATCAAGTCAGGTTATGCGGG	PSMB7
217	ATCAAGTCGGCCCGCTACCG	PSMB8
218	ATCAAGTCTATAGCGCCTCT	PSMB8
219	ATCAAGTGTTGGGACTAATA	PSMB8
220	ATCAATAACCGCGCTGCACA	PSMB8
221	ATCAATAATGACACCTACAC	PSMB8
222	ATCAATACCTGTCATGCAGC	PSMB8
223	ATCAATCTGCAGGACCAGCC	PSMB9
224	ATCAATGCCCCAGACCGCCC	PSMB9
225	ATCAATGCTGAAGAGCTCGT	PSMB9
226	ATCAATGCTGCCAAACAGAG	PSMB9
227	ATCAATGTGATTAGTATGAC	PSMB9
228	ATCAATTATTCAATCGTGAA	PSMB9
229	ATCAATTCGATGTTCGTATT	PSMB10
230	ATCAATTGTAAAGTCATCGT	PSMB10
231	ATCACAAAGCCACTGCAAAA	PSMB10
232	ATCACAAATTCTCGACGTCG	PSMB10
233	ATCACAACAGCCTATTACCG	PSMB10
234	ATCACAACCATCACTCGCGA	PSMB10
235	ATCACAACCTACTTCTGCAG	PSMC1
236	ATCACAACGATCTGTTCGTC	PSMC1
237	ATCACAATCAAAATCGTAAG	PSMC1
238	ATCACAATTAGTTTATACCG	PSMC1
239	ATCACACACATTGTAGCTCC	PSMC1
240	ATCACACACGTAACAACGAG	PSMC2
241	ATCACACCTCCCAGGGAGCA	PSMC2
242	ATCACACGACCAGAATAGTG	PSMC2
243	ATCACACGCGCTGCAACGTG	PSMC2
244	ATCACACTCACCATGGCACC	PSMC2
245	ATCACACTCCTCTGTCAATT	PSMC2
246	ATCACACTGAGCAACGAGGC	PSMC3
247	ATCACACTGCAATCAATATG	PSMC3
248	ATCACAGAATGGGCTGGCGT	PSMC3
249	ATCACAGACAACCTCTTCTC	PSMC3
250	ATCACAGACAGTGATGTAAA	PSMC3
251	ATCACAGAGGTAGTCACCCC	PSMC3
252	ATCACAGCAATTGTCCAGAC	PSMC4
253	ATCACAGCCCAGAGAGCAGA	PSMC4
254	ATCACAGCCGCACATGAGCT	PSMC4
255	ATCACAGCCTCAGACTCGAC	PSMC4
256	ATCACAGCTAATTCCGTCTC	PSMC4
257	ATCACAGCTCAAGAACTAAG	PSMC4
258	ATCACAGGCAGCATCGCCGA	PSMC5
259	ATCACAGGCCTTTACAACAT	PSMC5
260	ATCACAGGTGTGGCGATCGA	PSMC5
261	ATCACAGTCAACTATCGACT	PSMC5
262	ATCACAGTTAGTAGATTCGT	PSMC5
263	ATCACATACACTCTTCCTTC	PSMC6
264	ATCACATACCTACCAGTTTG	PSMC6
265	ATCACATATTCTCGAAAGAC	PSMC6
266	ATCACATATTCTCGCACAAT	PSMC6
267	ATCACATCCATTTGATCAGC	PSMC6
268	ATCACATCGATGAACTCGTC	PSMC6
269	ATCACATGGGTGTACACACA	PSMD1
270	ATCACATTCTACTATTGAAT	PSMD1
271	ATCACATTGTACGTGAGCAC	PSMD1
272	ATCACATTTCCAGAAACTCG	PSMD1
273	ATCACCAAGATGGACTTCGC	PSMD1
274	ATCACCAAGCCCGCGACCAA	PSMD1
275	ATCACCACAGCCTATTATCG	PSMD2
276	ATCACCACCGCATCATACTC	PSMD2
277	ATCACCACGTTCGACTTCAG	PSMD2
278	ATCACCAGCATCACTGTGTT	PSMD2
279	ATCACCATCATCGATGCCCC	PSMD2
280	ATCACCATCCTGGTCATTGC	PSMD2
281	ATCACCATGGTGCACTTCTG	PSMD3
282	ATCACCCACCTATTGCCACT	PSMD3
283	ATCACCCACTTGAAACTGCG	PSMD3
284	ATCACCCAGAAGTGTCCGAA	PSMD3
285	ATCACCCATCCCAAAGAATA	PSMD3
286	ATCACCCCCACTTAAGCCGT	PSMD3
287	ATCACCCGTACCTGTCGAAA	PSMD4
288	ATCACCCGTATCAACATAGC	PSMD4
289	ATCACCGACATGAAGGGAAC	PSMD4
290	ATCACCGACTTGTTAAAAGA	PSMD4
291	ATCACCGCGCTGTCCCACGG	PSMD4
292	ATCACCGTATGCATTGTTCC	PSMD4
293	ATCACCTTACCTTTAGGAGG	PSMD7
294	ATCACCTTCGTCCACCTAAC	PSMD7
295	ATCACCTTTGATGACCCCAA	PSMD7
296	ATCACGAAAGAATAACGCAT	PSMD7
297	ATCACGAAGTTACGAAGTCA	PSMD7
298	ATCACGACAGCGTACTACAG	PSMD7
299	ATCACGACTGCCTTTAGATG	PSMD8
300	ATCACGATGTCCCGCATGTG	PSMD8
301	ATCACGCCAGCAGACATCCG	PSMD8
302	ATCACGCCAGGAAAGCGACC	PSMD8
303	ATCACGCCATGCACGATCAG	PSMD8
304	ATCACGGCGGCTCAGCTTCA	PSMD8
305	ATCACTCACAGGATCCTTGG	PSMD11
306	ATCACTCACCTTTAACATAC	PSMD11
307	ATCACTCAGACTCCCCTCAC	PSMD11
308	ATCACTCAGACTCTATGGTG	PSMD11
309	ATCACTCCCCAGCCAGTCCG	PSMD11
310	ATCACTCCGGACATTTGCCC	PSMD11
311	ATCACTCTGGATACTGGCGA	PSMD12
312	ATCACTCTTGTTTCAATCTG	PSMD12
313	ATCACTGACAAACTTCCAGA	PSMD12
314	ATCACTGACCTTGGTGGCCG	PSMD12
315	ATCACTGAGACAATTGGCAA	PSMD12
316	ATCACTGAGTCCTTCTCGCC	PSMD12
317	ATCACTGATGAGACATGTCC	PSMD13
318	ATCACTGATGCTCGTCACAT	PSMD13
319	ATCACTGCCTTCAGCCCGAG	PSMD13
320	ATCACTGCGTTCCGTGTTCG	PSMD13
321	ATCACTGCTTCCTACGTTGC	PSMD13
322	ATCACTGGATTCACAGGATT	PSMD13
323	ATCACTGGCAATGTGATGTA	PSME1
324	ATCACTTACCTGCCCGTCTC	PSME1
325	ATCACTTAGTACCTATTTCA	PSME1
326	ATCACTTCCTACAACAGCCA	PSME1
327	ATCACTTCTCCAGTAAGCAT	PSME1
328	ATCACTTCTTTATTCCTACG	PSME1
329	ATCAGAAAAAAGCACCGTTG	PSME2
330	ATCAGAAACAGACGTCAGAC	PSME2
331	ATCAGAAACCTGGACTGTAT	PSME2
332	ATCAGAAAGAACCCCTCGTC	PSME2
333	ATCAGAACAGAAAGCTAGCT	PSME2
334	ATCAGAAGTCGGTTTAGTCA	PSME2
335	ATGACACCTGCCTCTCCCTT	RPL3
336	ATGACACCTTTGTGATGCTA	RPL3
337	ATGACACGAGCAGGCTTAAA	RPL3
338	ATGACACGATTAAGGTCCAT	RPL3
339	ATGACACTACAATAGCACTA	RPL3
340	ATGACACTCTTGAGCGGACG	RPL3
341	ATGACACTGTCATTACGTGC	RPL3L
342	ATGACAGATGCTTTAGTACA	RPL3L
343	ATGACAGATGGCCTTCTCAC	RPL3L
344	ATGACAGCCGGGCGTGGGTT	RPL3L
345	ATGACAGCTCCTTCAGGAAT	RPL3L
346	ATGACAGCTGAACCGCCTAA	RPL3L
347	ATGACAGCTTCTACAAGAAT	RPL4
348	ATGACAGTACCTCACAATGC	RPL4
349	ATGACAGTAGGATAGTGCAG	RPL4
350	ATGACAGTCTCATAATCCAA	RPL4
351	ATGACAGTGAAGACCCTGCA	RPL4
352	ATGACAGTGACATCACCCTC	RPL4
353	ATGACAGTTGAACAGTGCAG	RPL5
354	ATGACATACATACGAAAACC	RPL5
355	ATGACATACGTGATTTCTCC	RPL5
356	ATGACATAGTATTTAAAGCG	RPL5
357	ATGACATATTTTTCCTGCTC	RPL5
358	ATGACATCATCGAACTGATC	RPL5
359	ATGACATCCACCGTCAGTTC	RPL6
360	ATGACATCCCCAGTCTGTAA	RPL6
361	ATGACATCTTTCACAAGAAG	RPL6
362	ATGACATGATCGTCAACGTG	RPL6
363	ATGACATTCGAAACCAGTTG	RPL6
364	ATGACATTGCGCGTCTACGG	RPL6
365	ATGACCAAAACTGTGCCTTG	RPL7
366	ATGACCAACGACGCAAGTTT	RPL7
367	ATGACCAAGTGCATCTACTG	RPL7
368	ATGACCAATACACTCTTATA	RPL7
369	ATGACCACAAACTCAGCAAT	RPL7
370	ATGACCACACAAAGTAGTGC	RPL7
371	ATGACCACCCATGCTTTCTG	RPL7A
372	ATGACCACCTCGCCGGGCGC	RPL7A
373	ATGACCACTACCATCAGCGA	RPL7A
374	ATGACCAGCACACGATTGTG	RPL7A
375	ATGACCAGCTATAGCCCTGT	RPL7A
376	ATGACCATAGATTTGTTTCG	RPL7A
377	ATGACCATATAGATGTTGAG	RPL8
378	ATGACCATCCTGACGACACC	RPL8
379	ATGACCATCGCCTATGAAAG	RPL8
380	ATGACCATGAGGGTAGTCCC	RPL8
381	ATGACCATGATGTTGACCTA	RPL8
382	ATGACCATTGTATAGAACAC	RPL8
383	ATGACCCACGCGGACCACTC	RPL9
384	ATGACCCACTGTTGCTCCCC	RPL9
385	ATGACCCAGAGACTCGCGCG	RPL9
386	ATGACCCATACGTGCCAATG	RPL9
387	ATGACCCATCCTTGTAGTAG	RPL9
388	ATGACCCCCAAATCCAAACT	RPL9
389	ATGACCCCGTGGGCAGTCTT	RPL10
390	ATGACCCTATCGACGTGCCA	RPL10
391	ATGACCCTCTACTGGTCAGC	RPL10
392	ATGACCCTGCAGGGAGGTGC	RPL10
393	ATGACCGAACATCCCTGAAC	RPL10
394	ATGACCGAGCCAACCTAATG	RPL10
395	ATGACCGATGCTGCGCGTTC	RPL11
396	ATGACCGCAATGAACAGTGT	RPL11
397	ATGACCGCTGTGATGCGGGC	RPL11
398	ATGACCGGACCCCACTTCAC	RPL11
399	ATGACCGGTTACTTAATGTC	RPL11
400	ATGACCGTCCTCTTCGCCGT	RPL11
401	ATGACCTACCTCGTTGATGA	RPL12
402	ATGACCTAGTATTCTGTACC	RPL12
403	ATGACCTCACATCACTGCGT	RPL12
404	ATGACCTCCGCTCCATCCCG	RPL12
405	ATGACCTCGTTAGAGTAATT	RPL12
406	ATGACCTTAAATGCATCATC	RPL13
407	ATGACCTTACCCGGCTAGGA	RPL13
408	ATGACCTTGCTGATTTCCCG	RPL13
409	ATGACGAAGTCAACGTACTG	RPL13
410	ATGACGAATAGATTCAAATT	RPL13
411	ATGACGAGAACACCAAGCTC	RPL15
412	ATGACGATAACTTCGAGATC	RPL15
413	ATGACGATCTGAAGCTCATC	RPL15
414	ATGACGCACCTGTCCAACTA	RPL15
415	ATGACGCAGAGTCAGATGTC	RPL15
416	ATGACGCCGAGCGGGAGCGC	RPL15
417	ATGACGCCGGACAGGTCATC	RPL17
418	ATGACGGTAACTCGGAGGTA	RPL17
419	ATGACGTCTGTGAAGAAGTC	RPL17
420	ATGACGTGGTCAGCGTGCTG	RPL17
421	ATGACGTTATCTCTGAACTC	RPL17
422	ATGACGTTGCCCTTGCAGTA	RPL17
423	ATGACTACAGAAACCTGACT	RPL18
424	ATGACTACGACGACGTCCAG	RPL18
425	ATGACTACGCTCAACATGTT	RPL18
426	ATGACTATGATGTTAAGTTT	RPL18
427	ATGACTATGTGAATACCCAG	RPL18
428	ATGACTCAATTGGAGATGTT	RPL18
429	ATGACTCATCTACACGAGCC	RPL18A
430	ATGACTCCAAACGTTAGCTC	RPL18A
431	ATGACTCCCAACAGTATGAC	RPL18A
432	ATGACTCCCCGGATAGCAGC	RPL18A
433	ATGACTCTTCAGAAGCTTTG	RPL19
434	ATGACTGAAGAGATGACTAC	RPL19
435	ATGACTGAAGCAGAAGTTCG	RPL19
436	ATGACTGATTCTGACTGTAG	RPL19
437	ATGACTGCCGCGTCAACCTG	RPL19
438	ATGACTGGTGATCATCTATT	RPL19
439	ATGACTGTCATGTAGTGGAG	RPL21
440	ATGACTGTCCAATCACTATA	RPL21
441	ATGACTTACACGAAATCATT	RPL21
442	ATGACTTACATCTCCAGCAA	RPL21
443	ATGACTTACCCTCCTGCGTG	RPL22
444	ATGACTTACGATAGATTTGC	RPL22
445	ATGACTTAGTCATCCATTGC	RPL22
446	ATGACTTCATGGCCCGACTA	RPL22
447	ATGACTTCCAAGCTCCGGCG	RPL22
448	ATGACTTCCAGTTTGCTGAG	RPL22
449	ATGACTTCTCTAATCAGTTA	RPL23A
450	ATGACTTGCTCTACTAGATC	RPL23A
451	ATGACTTGTGGATCTTACTG	RPL23A
452	ATGACTTTCCACTGCTAAGT	RPL23A
453	ATGACTTTCTAGAACTTCTC	RPL23A
454	ATGACTTTGACCGCTTCTCG	RPL23A
455	ATGAGAAACAGAAAGCTGAA	MRPL23
456	ATGAGAAACTCGCCGAGAAG	MRPL23
457	ATGAGAAACTGTCTGTCCAA	MRPL23
458	ATGAGAACCAGCATAAAATC	MRPL23
459	ATGAGAACGAAGTAGTCTAC	MRPL23
460	ATGAGAAGAATCGCCTAAAC	MRPL23
461	ATGAGAAGACATTCATAACC	RPL24
462	ATGAGAAGACCGCCCAGACG	RPL24
463	ATGAGAAGTACTACAATTGC	RPL24
464	ATGAGACAAAGCGCACATCG	RPL24
465	ATGAGACAACAGCAGATGAC	RPL24
466	ATGAGACCGAGCTGTCCCTG	RPL26
467	ATGAGACTACAAGCACTGTT	RPL26
468	ATGAGACTACTGTGCCAGCG	RPL26
469	ATGAGAGAGAAGCACATCAA	RPL26
470	ATGAGAGAGATTCGACCAAC	RPL26
471	ATGAGAGATATTGATCGACT	RPL26
472	ATGAGAGCCCATTGTAGGTG	RPL27
473	ATGAGAGGCGCCGGGGACGT	RPL27
474	ATGAGAGGGCCACCCCCTCG	RPL27
475	ATGAGAGTGACCCAGCAGAG	RPL27
476	ATGAGATATGTACAATGGGA	RPL27
477	ATGAGATCGTACATCTCTCT	RPL27
478	ATGAGATCTCTGTCTACCAG	RPL30
479	ATGAGATGACCCGTATTATC	RPL30
480	ATGAGATGACTGTGAAGCAC	RPL30
481	ATGAGATGTATCCTGCAAGA	RPL30
482	ATGAGATTAGACGTCAAATC	RPL30
483	ATGAGATTCACCGCGAGCTG	RPL30
484	ATGAGATTGTATCCCAAAGA	RPL27A
485	ATGAGCACCAAGCCTACCGC	RPL27A
486	ATGAGCACCAGTTCCACCTT	RPL27A
487	ATGAGCACCATCTACAGTAC	RPL27A
488	ATGAGCACGTAGACCTCCGC	RPL27A
489	ATGAGCACGTGGTACCTGAG	RPL27A
490	ATGAGCACTTTGGTACTACT	RPL28
491	ATGAGCAGAGGGAGGGGGAG	RPL28
492	ATGAGCATCCGGATCTCCTC	RPL28
493	ATGAGCATGAAGTTAGTAAA	RPL28
494	ATGAGCCAGTCCCGAGCATG	RPL28
495	ATGAGCCCCGCTAGAAATCG	RPL28
496	ATGAGCCGCATCTACCACGA	RPL29
497	ATGAGCCTCACACATGAGTA	RPL29
498	ATGAGCCTCCATATGATGAA	RPL29
499	ATGAGCCTGTTCAGCCCCAC	RPL29
500	ATGAGCGAAGGGTGCGCAAG	RPL29
501	ATGAGCGAGACCGCCAGCCT	RPL29
502	ATGAGCGCAACGTCAGCACG	RPL31
503	ATGAGCGCTGGCGCGACGGC	RPL31
504	ATGAGCGTGGCCGGCCGCTC	RPL31
505	ATGAGCTCCCAAAGCCATCC	RPL31
506	ATGAGCTCCCAGCTGTCCGC	RPL31
507	ATGAGCTCGTTGGTCTCCTC	RPL31
508	ATGAGCTCTTAATATATCCC	RPL32
509	ATGAGCTGATTCTTCTAACC	RPL32
510	ATGAGCTGCAATCTCATCAC	RPL32
511	ATGAGCTGTACCGCGCCACC	RPL32
512	ATGAGCTTAGACGACATATG	RPL32
513	ATGAGCTTCAACCAGCTTTG	RPL32
514	ATGAGCTTGATCGCAAGTTC	RPL34
515	ATGAGGAAACTGAAGCTGAG	RPL34
516	ATGAGGAAATCGTACTTGAG	RPL34
517	ATGAGGAACTCGCTGAACGC	RPL34
518	ATGAGGAATCTGGCCTCTAT	RPL34
519	ATGAGGAGAACGAAGAGCGC	RPL34
520	ATGAGGAGCTGGCAGTGGGA	RPL35A
521	ATGAGGAGTTTGATGCTCGC	RPL35A
522	ATGAGGATCGCAAAGGACCA	RPL35A
523	ATGAGGCATGCGTGCGCCTG	RPL35A
524	ATGAGGCCCGAAACCGGTGT	RPL35A
525	ATGAGGCCTACAATGTGCAC	RPL35A
526	ATGAGGCCTGACATATCTGC	RPL36AL
527	ATGAGGCCTGGATCATGAGC	RPL36AL
528	ATGAGGCGGCGGCTGAACTC	RPL36AL
529	ATGAGGCTGTGCCCGAGTAC	RPL36AL
530	ATGAGGGATTGAAGTGGAGC	RPL36AL
531	ATGAGGGCAGCTCGATCTTT	RPL36AL
532	ATGAGGTCAGATACCATCAA	RPL37
533	ATGAGGTCAGATCTTGACAC	RPL37
534	ATGAGGTCCACAGCCCGCTT	RPL37
535	ATGAGGTGTACCAACCTAGG	RPL37
536	ATGAGGTTTCTTCACGCCGC	RPL37
537	ATGAGTACCTTGCCAGTTCC	RPL37
538	ATGAGTACGCCTATGCCAAG	RPL37A
539	ATGAGTAGACCAGTGATGAG	RPL37A
540	ATGAGTATACCACCATACGC	RPL37A
541	ATGAGTCCCCCGTAATCTTC	RPL37A
542	ATGAGTCGGAAATTTCCATC	RPL37A
543	ATGAGTCTCCTCGAGTCTGC	RPL38
544	ATGAGTGATGCCGTAGTCCA	RPL38
545	ATGAGTGCCATCGCCACCAA	RPL38
546	ATGAGTGCCATTGCCACTAA	RPL39
547	ATGAGTGCGATCGCTACCAA	RPL39
548	ATGAGTTACAGGATAATTAC	RPL39
549	ATGAGTTCACTATAGTGCTC	RPL39
550	ATGAGTTCTCCAATGTTTAG	RPL39
551	ATGAGTTTGTGTTCAATCAC	RPL39
552	ATGATAAGAGCCAAAACCTC	RPL41
553	ATGATAAGCCATCTGTAAGC	RPL41
554	ATGATACACCTCACAAAGTG	RPL41
555	ATGATACTCAAGCAATGCAG	RPL36A
556	ATGATAGTATATTGCTCCTT	RPL36A
557	ATGATATAGTAATCAGCTAG	RPL36A
558	ATGATATGAGAGAAGTCGCT	RPL36A
559	ATGATATTGTTTCAAGAACT	RPL36A
560	ATGATCAAAGTCGATGTACT	RPLP0
561	ATGATCAAGAACTCGCTGTT	RPLP0
562	ATGATCACCGTCAACCCCGA	RPLP0
563	ATGATCAGACCATCCGAGTG	RPLP0
564	ATGATCAGCACCAAAATCTC	RPLP0
565	ATGATCAGGCTTCACTCACA	RPLP0
566	ATGATCAGTACGTGAAGACG	RPLP1
567	ATGATCATTTGATAGCGAAG	RPLP1
568	ATGATCCACAGGTCTGGTTC	RPLP1
569	ATGATCCATTTAAAGTGTCG	RPLP1
570	ATGATCCCAAGCTTCCCCTC	RPLP1
571	ATGATCCCAATGACGATGAT	RPLP1
572	ATGATCCGCCCTTGCCTTAA	RPLP2
573	ATGATCCTGGCCTGCCTATT	RPLP2
574	ATGATCGACCTGAGTTACCA	RPLP2
575	ATGATCGCACCATCCGCATC	RPLP2
576	ATGATCGCATTATAAAGCAG	RPLP2
577	ATGATCGCCCTCGGCAGCCT	RPLP2
578	ATGATCGGGACATAGTTAAG	MRPL12
579	ATGATCGGGTGGCTGCGAAA	MRPL12
580	ATGATCTACCGAATTAAGGC	MRPL12
581	ATGATCTAGTCCTCCACTCC	MRPL12
582	ATGATCTATGTAGCCCGTGC	MRPL12
583	ATGATCTCGTAGCTCATGTC	MRPL12
584	ATGATCTGTGCCACCAATTA	MRPS12
585	ATGATCTTAGCTAAAGCTTC	MRPS12
586	ATGATCTTCACGTCGTCCAC	MRPS12
587	ATGATCTTGTCCACCGGCAA	MRPS12
588	ATGATGAAAGGGCATCGGTC	MRPS12
589	ATGATGAACACGCATACAAG	MRPS12
590	ATGATGCCTTCAAGATCTAC	RPS2
591	ATGATGCGCTCCACCAGCAC	RPS2
592	ATGATGCTATAGTTCTGACT	RPS2
593	ATGATGCTGGAAATCGACTT	RPS2
594	ATGATGCTTACCCTACTCAA	RPS2
595	ATGATGCTTCTCACTGTGTA	RPS3
596	ATGATGGATCCATGTTCAGT	RPS3
597	ATGATGGCTCCGTAGTGTAA	RPS3
598	ATGATGGGGATGTTGCACAC	RPS3
599	ATGATGGTTGCCTCTCAGAT	RPS3
600	ATGATGGTTTACCCTGACCC	RPS3
601	ATGATGGTTTCAGATAAAAA	RPS3A
602	ATGATGTAACTTCAGACTTT	RPS3A
603	ATGATGTACGCGCAGTCCAA	RPS3A
604	ATGATGTCAGACAATGCTAA	RPS3A
605	ATGATGTCTGCCTAGTAGCC	RPS3A
606	ATGATGTGAAATCCAACCGA	RPS3A
607	ATGATGTGTAGCCGATGCCA	RPS4X
608	ATGATGTTCTCAGTATTGTT	RPS4X
609	ATGATGTTGTCCAACACTAC	RPS4X
610	ATGATGTTTGCATCATCTTC	RPS4X
611	ATGATTACACTGAGCACAGA	RPS4Y1
612	ATGATTATACCTCCAATGTT	RPS4Y1
613	ATGATTATAGACCAGGGTTA	RPS4Y1
614	ATGATTATTTCCTTCTACGC	RPS4Y1
615	ATGATTCACCTCCAGCAGAA	RPS4Y1
616	ATGATTCAGCGATATTGCAA	RPS4Y1
617	ATGATTCATAAATCCAGAAG	RPS5
618	ATGATTCCATTGGGACGATC	RPS5
619	ATGATTCGAATCTTTCCCTA	RPS5
620	ATGATTCGAGATTTGTGTGA	RPS5
621	ATGATTCTCCCATTTCCACA	RPS5
622	ATGATTGAATCTTCTTGTGA	RPS5
623	ATGATTGACACCTCTGTGAG	RPS6
624	ATGATTGACCGCCTAGAAAA	RPS6
625	ATGATTGAGAGCGCTAACTA	RPS6
626	ATGATTGCCACGTCTGCAGT	RPS6
627	ATGATTGCTCTTGTTAAAGA	RPS6
628	ATGATTTCCATACTATTGAT	RPS6
629	ATGCACAACTCAACAACCTT	RPS7
630	ATGCACAATCATCTACTAAA	RPS7
631	ATGCACACGCCGATCTTGCG	RPS7
632	ATGCACACTTCTGTAGCCCT	RPS7
633	ATGCACAGCACTTCACTGCT	RPS7
634	ATGCACATCTGATCGGAATC	RPS7
635	ATGCACATGAGAGAGACAAG	RPS8
636	ATGCACATGCCCCGAATGCC	RPS8
637	ATGCACCAACATCACATAGA	RPS8
638	ATGCACCACTCTTTAGAAAC	RPS8
639	ATGCACCCAAGATTAATCCC	RPS8
640	ATGCACCCGATATACTGTCT	RPS8
641	ATGCACCCTATCTATGCCTA	RPS9
642	ATGCACCGATTGCTCTTAAG	RPS9
643	ATGCACCGGAGCATGTGTAC	RPS9
644	ATGCACCGGCCGCGCCGCCG	RPS9
645	ATGCACCGTTTCCTAGCAAC	RPS9
646	ATGCACCTACCCAAACCTGC	RPS9
647	ATGCACCTGCACATTCTCAG	RPS10
648	ATGCACGTTTCCTTAAAACG	RPS10
649	ATGCACTACTGCTCCACGAC	RPS10
650	ATGCACTCATGACCAACTTC	RPS10
651	ATGCACTGCATAAGCAGATG	RPS10
652	ATGCACTGGAACGAAAACGT	RPS10
653	ATGCAGAATGCCACCAAGTA	RPS11
654	ATGCAGACGCTCCGATTTCT	RPS11
655	ATGCAGACGGACTCTGGAAG	RPS11
656	ATGCAGAGGGCCACTGTCGT	RPS11
657	ATGCAGATGCTCGAGATTTC	RPS11
658	ATGCAGATTCTAGCCGTTAG	RPS11
659	ATGCAGCACCAGCAAGCCCG	RPS12
660	ATGCAGCATCACAGTGTCAC	RPS12
661	ATGCAGCCAATAATTACGCC	RPS12
662	ATGCAGCCAGTAATTACGCC	RPS12
663	ATGCAGCCCTGATAGCCGAC	RPS13
664	ATGCAGCCGGGCCTGAGCCC	RPS13
665	ATGCAGCCTCTTCTTCCGAC	RPS13
666	ATGCAGCGCAATTACCTACA	RPS13
667	ATGCAGCGGTGGAAGGCGTC	RPS13
668	ATGCAGCTACTATGAAGACG	RPS13
669	ATGCAGGCGGCTCCGCGCGC	RPS15
670	ATGCAGGGAGGAGGCCATAG	RPS15
671	ATGCAGGTCATGCACTATTT	RPS15
672	ATGCAGGTCCCGAACAGCAC	RPS15
673	ATGCAGGTTGCCAGCTAGGT	RPS15
674	ATGCAGGTTTCCAGCTATGA	RPS15
675	ATGCAGTACACATCCAATCC	RPS15A
676	ATGCAGTCATATGCAAGATC	RPS15A
677	ATGCAGTCCTCCGTGCCCCC	RPS15A
678	ATGCAGTCCTCGCTCACCTC	RPS15A
679	ATGCAGTCTGTGATTGAACT	RPS15A
680	ATGCAGTGCGCACGTTGACG	RPS15A
681	ATGCAGTGCTATATGGGTCA	RPS16
682	ATGCAGTTAATAAGTATAAA	RPS16
683	ATGCAGTTGTTAATGACTTC	RPS16
684	ATGCAGTTTCTTGAAAAGCA	RPS16
685	ATGCATAAAATCTCCAGAAA	RPS16
686	ATGCATAAAGAGTGTGCCGC	RPS16
687	ATGCATAACTCCCATAATCC	RPS17
688	ATGCATACTACCACCATTGC	RPS17
689	ATGCATATCATTCACGCATC	RPS17
690	ATGCATCATAAGCTCTAAAC	RPS17
691	ATGCATCATCTACACCCCTC	RPS17
692	ATGCATCGATGTAATTGTCC	RPS17
693	ATGCATGATCATGCTGATTA	RPS18
694	ATGCATGGCCCATGTAGACC	RPS18
695	ATGCATTTCATGCCAATACT	RPS18
696	ATGCATTTGTGCAAGTCCTG	RPS18
697	ATGCCAACAAGCTGAGCGAG	RPS18
698	ATGCCAACCCATTTGTCCTT	RPS18
699	ATGCCAACCCTCGAGTTGCT	RPS19
700	ATGCCAACTATGACGTCCAG	RPS19
701	ATGCCAAGCTCAGCGTGGAT	RPS19
702	ATGCCAATAACCTATGACAA	RPS19
703	ATGCCACACGCCTTCAAGCC	RPS19
704	ATGCCACATCCGTCTGGTCC	RPS19
705	ATGCCACCAAAAGTCCCCAT	RPS20
706	ATGCCACCGTAGCAGGCAAG	RPS20
707	ATGCCACCTACTGTAGTGGT	RPS20
708	ATGCCACCTCAACAATTCAG	RPS20
709	ATGCCACGATGGGCCTAATC	RPS20
710	ATGCCACGGAAGAGCTCCAG	RPS20
711	ATGCCAGAAATAAACGTCAG	RPS21
712	ATGCCAGCATCTCGTTCCAG	RPS21
713	ATGCCAGCTGGCTGCGGGCT	RPS21
714	ATGCCAGGCAGCCAGGGGGA	RPS21
715	ATGCCAGGGGGACCGCCGAC	RPS21
716	ATGCCAGTAATATGTTAGTG	RPS21
717	ATGCCAGTATGGCAACTCCT	RPS23
718	ATGCCAGTCTCCGCACCACG	RPS23
719	ATGCCATAGGATGAGCCGTA	RPS23
720	ATGCCATCAAAAACATGCGC	RPS23
721	ATGCCATCAGCATGTACGCA	RPS23
722	ATGCCATCAGGGCTATTCCA	RPS23
723	ATGCCATCATAGACTTCATA	RPS24
724	ATGCCATCATGGCCATCCGC	RPS24
725	ATGCCATGATCATCGACATG	RPS24
726	ATGCCATGGACAATATTACC	RPS24
727	ATGCCATTATGTGGGTCATG	RPS24
728	ATGCCATTCCAGACATTCTC	RPS24
729	ATGCCATTGATGAATATTAT	RPS25
730	ATGCCATTGCAGTGTCAACT	RPS25
731	ATGCCCAAGAAGTGACAGCC	RPS25
732	ATGCCCAATACTGCCAGATG	RPS25
733	ATGCCCATGCGGCCAACATC	RPS25
734	ATGCCCCATCTTCAATTGTC	RPS25
735	ATGCCCCATGAACACAGTCA	RPS26
736	ATGCCCCCTACGCCCTGCTG	RPS26
737	ATGCCCCGAAGCCAATCCGC	RPS26
738	ATGCCCCGAGTGATTACCAG	RPS26
739	ATGCCCCGAGTGCGACCAAC	RPS26
740	ATGCCCCGGAGGAGCGAGCT	RPS26
741	ATGCCCCGGCGGTCATCATC	RPS27
742	ATGCCCGAAGCCAACAGTTC	RPS27
743	ATGCCCGAGTGCTACATCCG	RPS27
744	ATGCCCGCACAAAACAGCTG	RPS27
745	ATGCCCGCCATGCCCTCCAG	RPS27
746	ATGCCCGCTTAGCTTCTCCA	RPS27
747	ATGCCCGGACTAAAGTAGAC	RPS27A
748	ATGCCCGTCGCCGGTACTAC	RPS27A
749	ATGCCCGTTCACTACCAGCA	RPS27A
750	ATGCCCTATCCTGAGAATAG	RPS27A
751	ATGCCCTATGTTCATTGGGC	RPS27A
752	ATGCCCTCGTTATCTTGAAA	RPS27A
753	ATGCCCTCGTTCTCGTCTAG	RPS28
754	ATGCCCTCTCTCCGCGAATG	RPS28
755	ATGCCCTGAACGAAAACATC	RPS28
756	ATGCCCTGACGAATATAAAG	RPS28
757	ATGCCCTGTGGACTCAGTTC	RPS28
758	ATGCCCTGTTCTAATCGAAC	RPS29
759	ATGCCGAACCAATTCTCCAC	RPS29
760	ATGCCGAAGCCCTTCATAAT	RPS29
761	ATGCCGAAGGTTCGCTAGTG	RPS29
762	ATGCCGAGCTTCTGATATTC	RPS29
763	ATGCCGAGTTCTTCTACAAC	RPS29
764	CACACACTAGGACTCTGTCC	UBA52
765	CACACACTATGGCGCTGAAA	UBA52
766	CACACACTCGATGCTGCCCG	UBA52
767	CACACACTGCCTTTCGCCAA	UBA52
768	CACACACTTGGCGGTTCTTT	UBA52
769	CACACAGAAGAGCTCCTGGC	UBA52
770	CACTAATGACTTATAGACCC	DDX39B
771	CACTAATGCCGTAGCCACTG	DDX39B
772	CACTAATTTAGAATCAATCT	DDX39B
773	CACTACAAACGCAACGAGAC	DDX39B
774	CACTACAAAGCTCAGTCTGA	DDX39B
775	CACTACAAATGTAGTGAGCG	DDX39B
776	CACTCACCCGGTTTCTGATC	SHFM1
777	CACTCACCGACTGGACGAGC	SHFM1
778	CACTCACCGCAGCACCATCC	SHFM1
779	CACTCACCGCAGTGTAGCCC	SHFM1
780	CAGCACCTGTGTGTGAATTG	DHX16
781	CAGCACCTTCCGGTAGCTGT	DHX16
782	CAGCACCTTGTAAACGTATA	DHX16
783	CAGCACCTTGTACACGTAAA	DHX16
784	CAGCACGAAGAGGTTGCGAG	DHX16
785	CAGCACGACATTGCGCGCCA	DHX16
786	CATAATAACCAGCTTCTAGC	BUD31
787	CATAATCATCATCCCGAGAC	BUD31
788	CATAATCCCATGCCTTGCGC	BUD31
789	CATCAGCTTCAATGTCTTAA	RPL14
790	CATCAGGACCCTCACGCTAC	RPL14
791	CATCAGGTTTGATGAAATCC	RPL14
792	CATCAGGTTTGGATATATAC	RPL14
793	CATCAGTAATGTCATCATCC	RPL14
794	CATTATCAAAACCTAAAAAG	EFTUD2
795	CATTATCACCATCATTACCG	EFTUD2
796	CATTATCAGGCTGTCGTTCC	EFTUD2
797	CATTATCAGTGTCATCCACC	EFTUD2
798	CATTATCCGGCAGCCCTCTG	EFTUD2
799	CATTATCCGGTCCTGAATCA	EFTUD2
800	CATTATTTATACTCGTTCCA	RPL23
801	CATTCAAAACCCTAGATAGC	RPL23
802	CATTCAACAAACATTTAATG	RPL23
803	CATTCAACAGAGGCAGTGAC	RPL23
804	CATTCAACAGCTCCTCTGAC	RPL23
805	CATTCAACTTGAGCGTGGCG	RPL23
806	CATTTCAGACCGCCTTCCTG	DDX23
807	CATTTCAGGCAAAATTAACA	DDX23
808	CATTTCAGGGATGTCGAATG	DDX23
809	CATTTCAGTGTGACAAAATT	DDX23
810	CATTTCCAACGTGTTAAACG	DDX23
811	CATTTCCAGACAACGCCATC	DDX23
812	CCAAGACCTTTCACCAGTGC	PSMF1
813	CCAAGACTCACATCCCCAGG	PSMF1
814	CCAAGACTCGTATTTGTGAC	PSMF1
815	CCAAGACTTAATATCCATTC	PSMF1
816	CCAAGAGAACCTTGACGTAT	PSMF1
817	CCAAGAGACACCCGTTTACC	PSMF1
818	CCAGAAACTGTAAACTTGTG	AQR
819	CCAGAAAGACCAGAACTAAC	AQR
820	CCAGAAAGCCTCTCCATTAC	AQR
821	CCAGAAAGTCCCGCGCGCTC	AQR
822	CCAGCCTCTGAAGTATCTCC	EIF4A3
823	CCAGCCTGAAATGTTTGACA	EIF4A3
824	CCAGCCTGCACCCTACGCAG	EIF4A3
825	CCAGCCTGCGTAATATCGAA	EIF4A3
826	CCAGCCTGGGCGATACAGTG	EIF4A3
827	CCAGCGGCTGTCGTCCACTG	DHX38
828	CCAGCGGGACATGTTCACCC	DHX38
829	CCAGCGGGCGTGTGATTACC	DHX38
830	CCAGCGGTTATCATCAACCC	DHX38
831	CCAGCTGGGGCTGCAGGGTT	MRPL19
832	CCAGCTGTAAGCTGTCCGCG	MRPL19
833	CCAGCTGTATGATCATACTG	MRPL19
834	CCAGCTGTCCAGAATTGACT	MRPL19
835	CCAGCTGTCCCCCGAGAACG	MRPL19
836	CCAGCTGTGTCTCTTCTAGC	MRPL19
837	CCAGTCCCGAATCAAAGATA	PSMD6
838	CCAGTCCGAAACACCGTCAA	PSMD6
839	CCAGTCCGACGTCATGATCG	PSMD6
840	CCAGTCCGAGTCACTGTCAC	PSMD6
841	CCAGTCCGGGTTGGCGATGC	PSMD6
842	CCAGTGTGTGGTTGGGGCCA	DDX46
843	CCAGTGTTCACTAATTCACT	DDX46
844	CCAGTGTTCGTTCCCGCACC	DDX46
845	CCAGTGTTTCACAACTACCC	DDX46
846	CCAGTGTTTCCACGTCGTGC	DDX46
847	CCAGTTAAGAAGTTAATACA	DDX46
848	CCCCCATCCAGTGTCGACCC	PSME3
849	CCCCCATTCCTCTCCAGTGA	PSME3
850	CCCCCATTTGTGCGATTTCC	PSME3
851	CCCCCCAACCAGCACCAGAC	PSME3
852	CCCCCCAAGCCCCGACACGC	PSME3
853	CCCCCCAAGTCCAACTGCAC	PSME3
854	CCCCCTTCAATGACCTCAAC	PSMD14
855	CCCCCTTCAGGTCTCACTTA	PSMD14
856	CCCCCTTCGTTAGTCGTATA	PSMD14
857	CCCCCTTCTCTTAATGTATG	PSMD14
858	CCCCCTTGATGTTCTACTTT	PSMD14
859	CCCCCTTGCTTACGCGTACT	PSMD14
860	CCCGAGCCGACTTAGCCCGC	BCAS2
861	CCCGAGCGACCGAGACCAGC	BCAS2
862	CCCGAGCTGAAAAGGTGCGC	BCAS2
863	CCCGAGGACATTCGTCAGAG	BCAS2
864	CCGACTCCAGGTCATAGTGC	CHERP
865	CCGACTCCTCTGTAAAACAT	CHERP
866	CCGACTCTGATCGTTATGAT	CHERP
867	CCGACTCTTCTTCAGCTTTG	CHERP
868	CCGACTGACGCTGAAGCTCT	CHERP
869	CCGACTGCAGTGCATCAAGC	CHERP
870	CCGCAAGAAGGGAGCCAAGC	MRPL28
871	CCGCAAGACCTCGAGCATCG	MRPL28
872	CCGCAAGACGCTGTTTGTGC	MRPL28
873	CCGCAAGCACCATCTGCCCG	MRPL28
874	CCGCAAGCGAGAGTTCAATA	MRPL28
875	CCGCAAGCTGGGCCTTTACA	MRPL28
876	CCTGCAGATCCCGTCATCGA	LSM6
877	CCTGCAGATGAATCCTCTCT	LSM6
878	CCTGCAGCAGCAGCGCTCGG	LSM6
879	CCTGCAGCAGGTCCTCACCC	LSM6
880	CCTGGCGGTACCTTTCGCGA	MRPL3
881	CCTGGCGTCTCCTGCGAGCC	MRPL3
882	CCTGGCGTGATCAAGACCAT	MRPL3
883	CCTGGCGTGCGCCCGTGTCC	MRPL3
884	CCTGGCTAAGCGTGATGTAC	MRPL3
885	CCTGGCTATCTCATCATCGC	MRPL3
886	CCTGGCTGATCTTCGCTGGA	RPL35
887	CCTGGCTGCTTGACCACCTC	RPL35
888	CCTGGCTGTACACACGTGTA	RPL35
889	CCTGGCTGTCCTAGCAGTTG	RPL35
890	CCTGGCTTACCTTCATTGGA	RPL35
891	CCTGGCTTCTCCCTAGTCTG	RPL35
892	CCTTACCTTGGTAATGGAAA	DDX42
893	CCTTACCTTGTTCTTGAAAT	DDX42
894	CCTTACCTTTCCCGGGACTA	DDX42
895	CCTTACGAAGCTTAACCCAA	DDX42
896	CGACAAGAGAGACTATCATC	ACIN1
897	CGACAAGCCTTGAAAGCTGT	ACIN1
898	CGACAAGCGCTATCGCGTGA	ACIN1
899	CGACAAGCTCGCCCAGTTCG	ACIN1
900	CGACAAGTGCTGTAATCACT	ACIN1
901	CGACAAGTTCAAGCTGAGTA	ACIN1
902	CGAGCCGACCGCGAGACTCC	MRPS27
903	CGAGCCGAGTCACTGCGTCC	MRPS27
904	CGAGCCGCAGCGACTTCGAG	MRPS27
905	CGAGCCGCTTCCTCACGGCT	MRPS27
906	CGAGCCGTAAAGCAGCACGT	MRPS27
907	CGAGCCGTACCAGATCCTGC	MRPS27
908	CGATGCCACCTGCGCGCCAA	PSME4
909	CGATGCCAGAGAACTTGAAC	PSME4
910	CGATGCCATCCAGGTCAGCG	PSME4
911	CGATGCCCAACAACGTGACT	PSME4
912	CGATGCCCAGCTACACAACC	PSME4
913	CGATGCCCGTCTATGGCCCG	PSME4
914	CGCTCCGCCGGTAGGCGTTC	RPL13A
915	CGCTCCGTTCGAGGCCCTAA	RPL13A
916	CGCTCCTACCAGTCTTCGCT	RPL13A
917	CGCTCCTCGACAATCCACTG	RPL13A
918	CGCTCCTTCCTTGTATTGCG	RPL13A
919	CGCTCGAGGAGCCTTCTCCG	RPL13A
920	CGGCAGCTGACAACCGAAGC	LSM5
921	CGGCAGGAAGATGGCGAACG	LSM5
922	CGGCAGGACAGGAGCGATTT	LSM5
923	CGGCAGGATGTCAACGAGTG	LSM5
924	CGGCAGGCCACTGCATTTCC	LSM5
925	CGGCAGGGATCGCGGGCGGG	LSM5
926	CGGGCGAGGGTGGGCGAGGG	LSM4
927	CGGGCGAGTGTACAATCATG	LSM4
928	CGGGCGATCCGTTGTCCGAA	LSM4
929	CGGGCGCAGCTCCAACCGAC	LSM4
930	CGGGCGCATGATGGCGGCCG	LSM4
931	CGGGCGCCTAGTCTACTCGC	LSM4
932	CGGTCTGTCTTCTGTACCAA	RPL36
933	CGGTCTTGTCTTCCGGGCAT	RPL36
934	CGGTGAAACCTTTGAATTTG	RPL36
935	CGGTGAAGCAGAAGCAGATT	RPL36
936	CGGTGAAGCCCAATGCAAAC	RPL36
937	CGGTGAAGGCGACCGTGGCG	RPL36
938	CTCACACTCACTCTTCTTGC	LSM3
939	CTCACACTCGCAGTGCAGAT	LSM3
940	CTCACACTTACCCTGGACCT	LSM3
941	CTCACACTTGAAGTAGCAGA	LSM3
942	CTCACACTTTGCGGTCATTG	LSM3
943	CTCACAGAAGATGGCGATGT	LSM3
944	CTCAGGACTCAACTGTTTTG	MRPS28
945	CTCAGGACTCTTCCATGCGT	MRPS28
946	CTCAGGAGAAGTCGGGAAGG	MRPS28
947	CTCAGGATCAAAGGATTCGA	MRPS28
948	CTCAGGATGACGTCTCCGAG	MRPS28
949	CTCAGGCATCCGGCACCCCG	MRPS28
950	CTCCAAGGTCCTCGCTAAGA	MRPL18
951	CTCCAAGTAGTAACTCCTCT	MRPL18
952	CTCCAAGTTTCTCCGCACCA	MRPL18
953	CTCCAATACAATAACATGCC	MRPL18
954	CTCCAATACCCGCACTGCTC	MRPL18
955	CTCCACGTAGAAGAGAGTCC	MRPL15
956	CTCCACGTCACACTCGCTCG	MRPL15
957	CTCCACGTCCGACACGTGCG	MRPL15
958	CTCCACGTTAGAAAGACACC	MRPL15
959	CTCCACGTTCACATCTCCGC	MRPL15
960	CTCCACGTTTCAAGAGCCGC	MRPL15
961	CTCCAGAGAATTTCTCCCCG	MRPL22
962	CTCCAGAGAGATCTTGGTAG	MRPL22
963	CTCCAGAGATACATCGGAAT	MRPL22
964	CTCCAGAGTAGACATGCTCA	MRPL22
965	CTCCAGATCAGCCAACCATC	MRPL22
966	CTCCAGATCAGCCTCCAACT	MRPL22
967	CTCTTTGCAGGGCACTTGGG	MRPS16
968	CTCTTTGCAGTGGTACACGC	MRPS16
969	CTCTTTGGAATGATTAATTG	MRPS16
970	CTCTTTGGTGAATAGCTGTG	MRPS16
971	CTCTTTGTAGGTACTGGTTT	MRPS16
972	CTCTTTGTCATCGATGTGAG	MRPS16
973	CTGAATGTCGACCAGCTCCT	RPS27L
974	CTGAATGTGGACCCCTGGGC	RPS27L
975	CTGAATGTGTCAAAGTCGCA	RPS27L
976	CTGAATGTGTTACGTGATCC	RPS27L
977	CTGAATGTTCTGAATCTCCG	RPS27L
978	CTGAATGTTCTTCGTCAAAC	RPS27L
979	CTGACAGGCCTAGACTCCCG	MRPL4
980	CTGACAGGTAGGTGGACAGA	MRPL4
981	CTGACAGGTCAGGGGAGTAC	MRPL4
982	CTGACCCCGGACGTGGATGA	MRPS7
983	CTGACCCCGGGCTCTCATGT	MRPS7
984	CTGACCCCGTACATGTATGC	MRPS7
985	CTGACCCCTTCTGTCTCCCT	MRPS7
986	CTGACCCTGCGAGTGCGCGA	MRPS7
987	CTGAGTCAGACCTACGCCAC	MRPS2
988	CTGAGTCATGCACCCAACAT	MRPS2
989	CTGAGTTGGCGTCCTCAGAG	RPL26L1
990	CTGAGTTTCCAAACGTGACG	RPL26L1
991	CTGAGTTTGGTGTCAGCTCC	RPL26L1
992	CTGATAAAAATCTTTAAACT	RPL26L1
993	CTGATAAAATCAGCTGCAGA	RPL26L1
994	CTGATAACTTCATCTCCCTC	RPL26L1
995	CTGCAGCGCTTCTCGCAGTA	RSL24D1
996	CTGCAGCGGCATTCACAACG	RSL24D1
997	CTGCAGCTACAACCAACTAG	RSL24D1
998	CTGCAGCTAGAGCTGATTAA	RSL24D1
999	CTGCCGGTCCAGCTCCTCCA	MRPL37
1000	CTGCCGGTGCAGCTGTCGGT	MRPL37
1001	CTGCCGGTTGGCATCGTACG	MRPL37
1002	CTGCCGTCAAACCAGAAGAC	MRPL37
1003	CTGCCGTCCCGAGTCCCAAT	MRPL37
1004	CTGCCTCTCGGTGATAAGCA	MRPL30
1005	CTGCCTCTGCGCGCTGCAGT	MRPL30
1006	CTGCCTCTGTTAAAACGTGC	MRPL30
1007	CTGCCTCTTGACCTTCAGCG	MRPL30
1008	CTGCCTCTTTGCCCTAAAAA	MRPL30
1009	CTGCCTGAAAACCTTCCGTA	MRPL30
1010	CTGCCTGATCTCATAGAGTC	MRPL27
1011	CTGCCTGCAGACCTTCCCGT	MRPL27
1012	CTGCCTGCAGGCGATCCTGA	MRPL27
1013	CTGCCTGCAGGCGTGAACGA	MRPL27
1014	CTGCCTGCATTCCCCTAGAC	MRPL27
1015	CTGCTGCGCGCCGCAACCAG	MRPL35
1016	CTGCTGCGTCGAGCCGCCCG	MRPL35
1017	CTGCTTCTCACCTTCATATA	CRNKL1
1018	CTGCTTCTCGGTTTGCGTAG	CRNKL1
1019	CTGCTTCTGTTTGCATGACC	CRNKL1
1020	CTGCTTCTTGCTGTACAAAA	CRNKL1
1021	CTGCTTGAATTGTTCCTCGT	CRNKL1
1022	CTGCTTGACAGGCCGGACAG	CRNKL1
1023	CTGGACAATATGCCACTCCG	CDC40
1024	CTGGACAATCAAACATAGTG	CDC40
1025	CTGGACACCTGCTGGGCCTC	CDC40
1026	CTGGACAGGATGAGAGTGTC	CDC40
1027	CTGGACAGGCGGGCATATGC	CDC40
1028	CTGGACAGGTGCATCATCGC	CDC40
1029	CTGGAGCCTCTCGTCCTCAC	MRPS17
1030	CTGGAGCGCCTCTCCGTGAA	MRPS17
1031	CTGGAGCGCTACCTCTCGAT	MRPS17
1032	CTGGAGCTGTTTGAGGCGGC	MRPS17
1033	CTGGAGGACAACAAGCTGCC	MRPS17
1034	CTGGAGGACGATACACATGA	MRPS17
1035	CTGGTCTCTGACATACGAAG	CWC15
1036	CTGGTCTGGCCCGTAGGCAG	CWC15
1037	CTGGTCTTCTCCCCCGCAGC	CWC15
1038	CTGGTGACCGACAATTACAC	CWC15
1039	CTGGTGAGAAGTTTGCGCTG	CWC15
1040	CTGTGGGGAATCTCACTTGC	MRPS23
1041	CTGTGGGGGGTCCCCGAAAA	MRPS23
1042	CTGTGGGGTCTGTCTTCAAC	MRPS23
1043	CTGTGGGTACCTCCTCATAC	MRPS23
1044	CTGTGGGTAGAGAGGAGCTG	MRPS23
1045	CTGTGGGTGACACGTCCCTG	MRPS23
1046	CTGTTCTGGAGGTTGCTGAG	LSM7
1047	CTGTTCTGGCAAATCACACC	LSM7
1048	CTGTTCTGGCATCCGTGAAC	LSM7
1049	CTGTTCTTCCCTAGAATGTC	LSM7
1050	CTGTTGAAGATGTTATTGTT	LSM7
1051	CTGTTGAATGCCCTCCACCT	LSM7
1052	CTTCAGCAAACATTGTAAAC	MRPL39
1053	CTTCAGCAAAGGGCAGCTAC	MRPL39
1054	CTTCAGCAACCAGATCCCGC	MRPL39
1055	CTTCAGCAACCAGCAGTCAC	MRPL39
1056	CTTCAGCAATTCCAGACTTC	MRPL39
1057	CTTCAGCACACAACGCCACT	MRPL39
1058	CTTCCCCATGGCCGACCCTG	MRPS21
1059	CTTCCCCGAGCGCTGCGCCA	MRPS21
1060	CTTCCCCGCTCAACTGCATC	MRPS21
1061	CTTCCCCGGTGTAAGTCAGC	MRPS21
1062	CTTCCCCGTGAGGGAAGCCC	MRPS21
1063	GAAAGTGCCCAAGCCCATCA	CCDC40
1064	GAAAGTGCCCCAAGTCCCAA	CCDC40
1065	GAAAGTGCGAACCACGCTGA	CCDC40
1066	GAAAGTGGTCTAGCAAAGTG	CCDC40
1067	GAAAGTGGTTGCCTTAGATT	CCDC40
1068	GAAAGTGTGCTCCATGTCAT	CCDC40
1069	GAACATTGAGTACAGCTGCC	MAGOHB
1070	GAACATTGATAATGCCAAAC	MAGOHB
1071	GAACATTGCACGATGCCTCC	MAGOHB
1072	GAACCAAAGCTTCAAGTTCT	MAGOHB
1073	GAACCAACACTCGATCACCG	MAGOHB
1074	GAACCAACAGCTATGTTCAA	MAGOHB
1075	GAACTGGCTGAAGAAGCGCA	MRPS10
1076	GAACTGGGAGAATACTCGCT	MRPS10
1077	GAACTGGGCCTTCAGCACGG	MRPS10
1078	GAACTGGTACACCAACTCGT	MRPS10
1079	GAACTGGTCGCTGCCATCGT	MRPS10
1080	GAACTGTACGTGAACCACAA	MRPS10
1081	GACATCTGCATCAACAATGC	URGCP-MRPS24
1082	GACATCTTTGAGCGTATCGC	URGCP-MRPS24
1083	GACATGAACCACCCGCCCAG	URGCP-MRPS24
1084	GACATGATGCAGAAGCTCTC	URGCP-MRPS24
1085	GAGATATGCTTTGCCGTTAA	CTNNBL1
1086	GAGATCAAAACAAGCCCTCC	CTNNBL1
1087	GAGATCAAGACAAGCAAGTG	CTNNBL1
1088	GAGATCAAGCAGCCCGTATT	CTNNBL1
1089	GAGATCAATCAGCTGATCGC	CTNNBL1
1090	GAGATCACCGCGCAACCCGA	CTNNBL1
1091	GATCCACTCCGACTCAGACG	ISY1
1092	GATCCACTTGTGCCGTAAGA	ISY1
1093	GATCCAGAAGAACCGCCGAG	ISY1
1094	GATCCAGATCGAGAGTGCCG	ISY1
1095	GATCCAGATTCTTAAACAGC	ISY1
1096	GATCCAGCCCACCATGACGA	ISY1
1097	GATTTCAACTGAAGTAATGA	LSM2
1098	GATTTCAAGCGAATGAAGAA	LSM2
1099	GATTTCAATATCCAAACAAC	LSM2
1100	GATTTCAATGTTTCCCACTT	LSM2
1101	GATTTCACCTCAAGTCGATC	LSM2
1102	GATTTCAGAAGTTATTCCGA	LSM2
1103	GCACGGATCCGATCAGCACC	MRPL17
1104	GCACGGATCCGCTGTCCCAA	MRPL17
1105	GCACGGCAATCCCGTGCTCA	MRPL17
1106	GCACGGCACAACCATCTCCC	MRPL17
1107	GCACGGCCACTCTTACACCA	MRPL17
1108	GCACGGCCATGGTAGCCCAC	MRPL17
1109	GCAGTGCCGGCAACGCTGTG	MRPS25
1110	GCAGTGCCTGCATATATGAC	MRPS25
1111	GCAGTGCGTGAAGTACATTC	MRPS25
1112	GCAGTGCGTTCAGTGCAAAA	MRPS25
1113	GCCACGGAGTGCATGATCTT	MRPS26
1114	GCCACGGTGATCACAAAAAG	MRPS26
1115	GCCACGTACCGGCGCTGACA	MRPS26
1116	GCCACGTAGGTGAAGAGACG	MRPS26
1117	GCCACGTATTCATCACGCTC	MRPS24
1118	GCCACGTCCTCTAAGCTCTC	MRPS24
1119	GCCACGTCCTTGAAGCTCAA	MRPS24
1120	GCCACGTCTGGCACGAACAC	MRPS24
1121	GCCACGTCTTTCTTCTCGCT	MRPS24
1122	GCCACGTGACAAGTCATATC	URGCP-MRPS24
1123	GCCACGTGAGGTATGACCGG	MRPS24
1124	GCCACGTGCCTTCCTGATTT	MRPS15
1125	GCCACGTGGACATCTTTCAC	MRPS15
1126	GCCACTAGAGTTCATCGTTA	MRPS15
1127	GCCACTATCTCCTCGTACTT	MRPS15
1128	GCCACTCACATCAAACCTGC	MRPS15
1129	GCCACTCACCTGCCCACAGC	MRPS15
1130	GCCACTCACGAGTCAAGTAC	MRPS11
1131	GCCACTCACGCTGAACTCGC	MRPS11
1132	GCCACTCACTGTGTGACACC	MRPS11
1133	GCCACTCACTTTGAACTTTC	MRPS11
1134	GCCACTCAGGCATCCAATAG	MRPS11
1135	GCCACTCAGTTCAACATCAC	MRPS9
1136	GCCACTCATCTTCGTTGTCC	MRPS9
1137	GCCACTCCCGCCTCTTCCCC	MRPS9
1138	GCCACTCCTCCAAAACATTC	MRPS9
1139	GCCACTCCTGCCCCATTCAT	MRPS6
1140	GCCACTCCTGCCCCATTTAT	MRPS6
1141	GCCACTCGGGCTTGTAGTGC	MRPS6
1142	GCCACTGACCCTCGACAACC	MRPS6
1143	GCCACTGACTCTACCAGCAT	MRPS6
1144	GCCACTGCAGGTCGTGGACG	MRPS6
1145	GCCACTGCTTCGCCTGGTGC	MRPS5
1146	GCCACTGGCATTGAAGTAAC	MRPS5
1147	GCCACTGGGAATGCTCCCTG	MRPS5
1148	GCCACTGGGGGAGGAAGGAC	MRPL41
1149	GCCACTGTAGAAGACCCTGC	MRPL41
1150	GCCACTGTCACTCCTCAGAA	MRPL41
1151	GCCACTGTTCACGTGAAGAA	MRPL41
1152	GCCACTTAACCCTATCCTCG	MRPL41
1153	GCCACTTCTACTACCGCACC	MRPL38
1154	GCCACTTGACTGTGTTTCTC	MRPL38
1155	GCCACTTGATCATATTCCGC	MRPL38
1156	GCCACTTGCTCTGCTTCGCC	MRPL38
1157	GCCACTTGCTGAGCCAAATA	MRPL38
1158	GCCACTTTCAAGCACAATAT	MRPL38
1159	GCCACTTTCCAAAAGCCGCT	MRPL36
1160	GCCAGAAAAAGTTATCAGAT	MRPL36
1161	GCCAGAAAACAACATAGGCA	MRPL36
1162	GCCAGAAAATCACCATAGCA	MRPL36
1163	GCCAGAAATACCTTGTAACT	MRPL36
1164	GCCAGAACTCAGAAAAGCCA	MRPL36
1165	GCCAGAACTGATTAGCCGTC	MRPL34
1166	GCCAGAAGACATGAGCCCTT	MRPL34
1167	GCCAGAAGAGATCGTGACGA	MRPL34
1168	GCCAGAAGCACCGGTACCTT	MRPL34
1169	GCCAGAAGCCAATGCCTGTG	MRPL34
1170	GCCAGAAGCGTTCTCTTTAT	MRPL34
1171	GCCAGAAGTAACTTGTACTC	MRPL32
1172	GCCAGAAGTAGCTTGTATTC	MRPL32
1173	GCCAGAATCATGGGCTGCTG	MRPL32
1174	GCCAGACAAAGAGATCGTGC	MRPL32
1175	GCCAGACATATTCGAAGTCC	MRPL32
1176	GCCAGACATGAAGTCGCGCT	MRPL32
1177	GCCAGACCCCTCAGCTTTGC	MRPL11
1178	GCCAGACCCCTTGAGCAAAC	MRPL11
1179	GCCAGACCTAATATCCCAGC	MRPL11
1180	GCCAGACCTACCTCGAGGCT	MRPL11
1181	GCCAGACCTGATCACCTGTC	MRPL11
1182	GCCAGACCTGATCGCCCATC	MRPL11
1183	GCCAGACCTGATTACCTGTC	MRPL9
1184	GCCAGACCTGATTACTTATC	MRPL9
1185	GCCAGACCTTCACTAGCTCC	MRPL9
1186	GCCAGACGAGACCAATCATC	MRPL9
1187	GCCAGACGATCGATGAAAGT	MRPL9
1188	GCCAGACTCATTTGCCCCGC	MRPL9
1189	GCCTACAGCCTTGGCTCCTT	MRPL24
1190	GCCTACATGGCCGAGGTAGA	MRPL24
1191	GCCTACCAAAACGTCAACAT	MRPL24
1192	GCCTACCACAAAGGTGTCGT	MRPL24
1193	GCCTACCACGATGGCATCGC	MRPL24
1194	GCCTACCCCAACACCGGCCC	MRPL24
1195	GGCAGAGTCACCTGTCGGTC	NAA38
1196	GGCAGAGTTCTGAGCTTATC	NAA38
1197	GGCAGAGTTGGACAAGTACC	NAA38
1198	GGCAGATAGGGCACTGGGCT	NAA38
1199	GGCAGATATGTGATAGGCAT	NAA38
1200	GGCAGATCATCAGCCCACGT	NAA38
1201	GTCTACCTGTGCACATCTGC	PSMB11
1202	GTCTACGACATTACTGACCG	PSMB11
1203	GTCTACGAGACCCTCCGCTT	PSMB11
1204	GTCTACGCAGATTAATCATC	PSMB11
1205	GTCTACGCCATCGGACTCAT	PSMB11
1206	GTCTACGGCTTCAGTGTGGT	PSMB11
1207	GTGACACACAAGCACCACAC	MRPL10
1208	GTGACACATTGATGCGTGCC	MRPL10
1209	GTGACACCAACCTGATCTGA	MRPL10
1210	GTGACACCAGTCAAAAACAG	MRPL10
1211	GTGACACGGGACCGGGTGCG	MRPL10
1212	GTTTGGATGCTTGACTCACG	RPL10L
1213	GTTTGGATTAGCAAGATGAC	RPL10L
1214	GTTTGGCAACCAGTTCCAAA	RPL10L
1215	GTTTGGCCAGCGGTAGGTCG	RPL10L
1216	GTTTGGGAACCGGACTCTGC	RPL10L
1217	GTTTGGGACAGCAATCACAT	RPL10L
1218	TAAATAGGGACTTTCCCGGG	PSMA8
1219	TAAATATAATTCACACTCCT	PSMA8
1220	TAAATATACCCTTCTCCATT	PSMA8
1221	TAAATATAGAGACCATACTA	PSMA8
1222	TAAATATCCCCACAGACACC	PSMA8
1223	TAAATATGAGGGCCTTCTTA	PSMA8
1224	TAAGAATATTCCTATGACCC	HNRNPA1L2
1225	TAAGAATCACGTAGTTCAAT	HNRNPA1L2
1226	TAAGAATCCCTCATCGACCC	HNRNPA1L2
1227	TAAGAATTACCTAGCTAGCG	HNRNPA1L2
1228	TAAGAATTCCCCACTCCTCC	HNRNPA1L2
1229	TAAGAATTCGGCGGCATGTG	HNRNPA1L2
1230	TACTAGCTGGTTAGATACAT	CCDC12
1231	TACTAGGTTGGAGAAACGTA	CCDC12
1232	TACTAGTCTCCCTCCATCTC	CCDC12
1233	TACTATACTCATCAGAGAAC	CCDC12
1234	TACTATAGGGTCCTGGTTAC	CCDC12
1235	TACTATATGCTTTTTAAATG	CCDC12
1236	TCACCCGAATGTGTACCCTT	RPL22L1
1237	TCACCCGACAAATCTTGACA	RPL22L1
1238	TCACCCGACTCCACATAGAT	RPL22L1
1239	TCACCCGACTGGAGTTCCCT	RPL22L1
1240	TCACCCGAGAACATGCATCC	RPL22L1
1241	TCACCCGCACCACGCGTACC	RPL22L1
1242	TCAGGCTCTTGGGACCTAGG	MRPL21
1243	TCAGGCTGCTCTGCGGCGTG	MRPL21
1244	TCAGGCTGTCCAGAAGTAAA	MRPL21
1245	TCAGGCTGTGATTTCAAGCC	MRPL21
1246	TCAGGCTGTTCCTGTCAGGC	MRPL21
1247	TCAGGCTTACCCGGAACCGC	MRPL21
1248	TCATAGTCAGTATTGAACAG	HNRNPA3
1249	TCATAGTCCGCGATCACCTG	HNRNPA3
1250	TCATAGTGAACCACCCGCTC	HNRNPA3
1251	TCATAGTTACTGCAGCCAAG	HNRNPA3
1252	TCATATAACTGAGCGTATTG	HNRNPA3
1253	TTCGCTGTCACTCCGAAAAC	URGCP-MRPS24

EXAMPLES

Example 1

Materials and Methods

GeCKO v2 CRISPR Screening

Cancer cell lines were transduced with a lentiviral vector expressing the Cas9 nuclease under blasticidin selection (pXPR-311Cas9). These stable polyclonal cell lines were then infected in replicate (n=3) at low multiplicity of infection (MOI<1) with a library of 123,411 unique sgRNAs targeting 19,050 genes (6 sgRNAs per gene), 1,864 miRNAs and 1,000 non-targeting control sgRNAs, selected in puromycin and blasticidin for 7 days and then passaged without selection while maintainingwith a representation of 500 cells per sgRNA until a defined time point. Genomic DNA was purified from end cell pellets and the guide sequence PCR amplified with sufficient gDNA to maintain representation, and quantified using NGS.

Cas9 Activity Assay

Cancer cell lines expressing stable Cas9 under Blasticidin selection were transduced with a lentivirus with and EF1a driven puromycin-2A-GFP cassette, and a U6 driven sgRNA targeting GFP (pXPR_011) (11). The initial level of GFP is measured with FACs and monitored over time as a measure of cells harboring modified alleles. Cells with GFP remaining are due to either modifications than do not inactivate GFP florescence or inactive Cas9.

Quality Control

Quality control measures were used to remove cell line replicate samples where (1) the SNP genotype fingerprint failed to match the reference cell line as described in Cowley et al. (14), (2) the reproducibility between replicates was less than 80% and (3) principal component analysis showed a replicate or cell line to be an outlier. Additional time points for those cell lines that had multiple time points, were also removed from the final dataset and downstream analysis.

Positive Controls

Positive controls for ribosome, proteasome and spliceosome subunits were pulled from KEGG gene set lists for those complexes. Guide sequences that were a perfect match to sgRNAs targeting any other gene were removed, except when specifically utilized in described analyses. The median of all remaining sgRNAs were used to correlate to Cas9 activity, etc.

Data Processing

Data were processed in a reproducible GenePattern pipeline consisting of several modules. Briefly, raw read counts were normalized to the total read depth for each replicate, then log-2 transformed before removing failed replicates and calculating a fold change per sgRNA. The median of non-targeting controls (n=1000) in the GeCKOv2 library were subtracted from each sgRNA and this corrected fold change data was normalized using a Llowess procedure. To calculate a gene-level score we used ATARiS at a p-value threshold of 0.05, a previously described method to calculate gene levels scores in shRNA data (15)

Copy Number Analysis

CRISPR-Cas9 screening data were mapped according to genomic position of sgRNA sequence (guide-level data) or target gene (by ATARiS algorithm) to the human genome version 19 (hg19). CRISPR-Cas9 dependency data were plotted in parallel to Project Achilles shRNA dependency data (14)(http://www.broadinstitute.org/achilles) or Cancer Cell Line Encyclopedia copy number or gene expression data (12, 14). Segmentation of copy number data was performed using the ReCapSeg algorithm designed by the Broad Institute.

Example 2

CRISPR-Cas9 Screening in Cancer Cell Lines

To investigate the utility of the CRISPR-Cas9 approach to identify acquired genetic dependencies across cancer cell lines, Applicants performed genome-scale pooled screening in 43 cancer cell lines representing a diversity of cancer types and genetic contexts of both adult and pediatric lineages (Table 1; FIG. 1A). CRISPR-Cas9 screens in cancer cell lines were performed utilizing the GeCKOv2 CRISPR-Cas9 system in which Cas9 and the sgRNA are expressed from separate lentiviral vectors (9). Cancer cell lines were transduced with a lentiviral vector expressing the Cas9 nuclease under blasticidin selection. These stable cell lines were then infected in replicate (n=3) at low multiplicity of infection (MOI<1) with a library of 123,411 unique sgRNAs targeting 19,050 genes (6 sgRNAs per gene), 1,864 miRNAs and 1,000 non-targeting control sgRNAs, selected in puromycin and then passaged with an average representation of 500 cells per sgRNA until a defined time point (FIG. 1A). At the indicated time points, the abundance of sgRNAs in these cells was quantitated from genomic DNA by massively parallel sequencing. The abundance sgRNAs at the endpoint was compared to the abundance in the plasmid pool used for virus production to define the relative drop-out or enrichment in the screen (FIG. 1A).

Applicants initially nominated a small number of cancer cell lines to be screened as a pilot (Table 1) for quality assessment, identification of an optimal endpoint and measurement of the performance of positive and negative control sgRNAs in the library. At 7, 14, 21 and 28 days post-infection in a single cell line, the log₂ normalized read counts of the 1000 non-targeting sgRNAs show little difference compared to the initial DNA reference pool, indicating that non-targeting guides have no substantial effect on viability (FIG. 1B). As positive controls, Applicants also compiled a list of 264 putative cell essential genes that are part of the ribosome, proteasome or spliceosome complexes (Table 2). In contrast to the non-targeting guides, the read counts of these positive controls in late time point samples were depleted compared to the initial reference pool. The levels of depletion of the positive controls increased over time with a more substantial change between 7 and 14 days compared to the change between 14 and 21 or 28 days (FIG. 1B). Additional cell lines within this pilot set were screened at 14 and 28 days, and showed similar trends, indicating Applicants can detect depletion of essential genes. Based on these data, Applicants selected a 21-day endpoint for subsequent screens, and used the 28 day time point for those screens already completed. This time-course to depletion of cell essential genes in CRISPR-Cas9 pooled screening appears comparable to that observed previously with shRNA pooled screening (10).

Applicants next selected a larger panel of cancer cell lines for CRISPR-Cas9 screening representing variety of lineages and genetic contexts to enrich the diversity of possible dependencies observed. Additionally, Applicants screened multiple cell lines from a few specific lineages (pancreatic cancer, osteosarcoma and rhabdoid) to evaluate lineage-specific dependencies in these lines (Table 1). Applicants screened each subsequent cell line to either a 21- or 28-day endpoint with a primary focus on negative-selection screening for those sgRNAs that are most depleted in the screen. Quality control measures were used to remove cell line replicate samples where the reproducibility between replicates was less than 80% (FIG. 1C) or principal component analysis showed a replicate or cell line to be an outlier (FIG. 1D).

Since differences in Cas9 activity across cell lines may result in differential efficiency of genome editing, Applicants measured Cas9 activity across all 43 cell lines screened using a recently described one-vector GFP Cas9 activity assay (11). Applicants first determined the optimal time point for assessing Cas9 activity over 20 days. Although Applicants observed peak genome editing in some cell lines after 7-9 days, Applicants found that 12-14 days was required to ensure that genome editing reached a maximum in all cell lines (FIG. 1E and Table 1). Applicants found considerable variability in GFP Cas9 activity across the panel of cell lines at the 12-14 day time point, ranging from greater than 95% to approximately 30% (Table 1). Applicants also looked at the median depletion of positive control sgRNAs, as defined above, as a measure of the efficiency of genome editing and cell essential gene depletion across cell lines. This also varied considerably across cell lines (FIG. 1F), suggesting that the cutting efficiency of the Cas9-sgRNA complex varies across cell lines. The GFP Cas9 activity assay correlated strongly to the above described median normalized log 2 fold change of positive controls across cell lines (R=0.5745, Pearson) (FIG. 1F). Furthermore, principal component analysis also shows a correlation of the first principal component in the sgRNA level data to Cas9 activity (FIG. 1G). These observations suggest that Cas9 activity profoundly impacts determination of dependencies in cancer cell lines. The ability to compare the essentiality of genes across cell lines is vital to the goal of identifying preferential dependencies in a genotype or phenotype-specific manner; therefore, to ensure effective Cas9 activity across lines, Applicants excluded cell lines with an activity score below 45% (% GFP remaining is above 55%) from further analysis (Table 1). Importantly, the GFP Cas9 activity assay is a reasonable method for pre-screening assessment of Cas9 activity while comparison of the positive-to-negative depletion ratio across cell lines offers an attractive means of assessment of Cas9 activity calculated directly from screening data.

Example 3

Identification of Oncogene Dependencies

Applicants next evaluated whether CRISPR-Cas9 screening effectively identifies known oncogene dependencies in cancer cell lines. Applicants observe clear dependency of cancer cell lines on CRISPR-Cas9 mediated knock-out of mutated, rearranged and over-expressed oncogenes in a genotype- and phenotype-specific fashion (FIG. 2). Notably, KRAS-mutant cell lines appear dependent on KRAS for proliferation and viability in the screen (FIG. 2A). The BCR-ABL translocated leukemia cell line K562 shows strong dependence on the ABL1 kinase (FIG. 2B). Moreover, Applicants also see strong dependency of estrogen-receptor-positive breast cancer cells on expression of the estrogen receptor and androgen-receptor positive prostate cancer cells on expression of the androgen receptor (FIG. 2C-D).

Example 4

Genomic Copy Number Determines Sensitivity to CRISPR-Cas9 Genome Editing

Amplification of genomic segments of DNA harboring oncogenes may drive tumor survival and progression. Functional genetic screening of all genes within a region of genomic amplification may enable identification of key driver oncogenes residing within these regions. To investigate the ability of CRISPR-Cas9 screens to identify driver oncogenes responsible for cancer cell proliferation and survival within amplified regions, Applicants mapped functional gene dependency data by genomic coordinates and intersected these data with DNA copy number information available for 32 independent lines from the Cancer Cell Line Encyclopedia (12). Applicants observed a striking correlation of local genomic copy number with regions that scored as highly dependent when targeted by CRISPR-Cas9 in cancer cell lines. In particular, copy number gain or amplification appear to confer increased sensitivity to targeting of CRISPR-Cas9 to the amplified segments of DNA (FIGS. 3A-C). High-level amplifications of regions of DNA including known driver oncogenes, such as AKT2, MYC, KRAS or CDK4, showed strong susceptibility to sgRNAs targetingof not only these driver oncogenes, but also essentially all other genes within the amplified loci (FIGS. 3A-C). Survey of this correlation across multiple cancer cell lines screened with genome-scale CRISPR-Cas9 technology, reveals that the dependency-copy number correlation is pervasive within and across a subset of cell lines and is observed within focal and broad-level copy number alterations (FIG. 3D). RNA-interference screening data mapped to regions of amplification did not show this global dependency within the amplified segments of DNA, and only a small number of genes appeared dependent by RNAi in most loci (FIG. 3B-C). Thus, the strong copy number-dependency correlation appears specific for CRISPR-Cas9 technology and is not observed in RNAi-screening data, thereby suggesting that important mechanistic properties of CRISPR-Cas9 are responsible for this phenotype.

Applicants have observed that this phenomenon in CRISPR-Cas9 screening data is not limited to expressed protein-coding genes. First, Applicants see that CRISPR-Cas9 dependency within amplified genomic regions does not correlate with mRNA gene expression (FIG. 3E), therefore suggesting that the etiology of this dependency does not necessarily relate to reduced expression of protein-coding genes and may result from DNA modification or damage itself. Moreover, Applicants have systematically analyzed perfect match off-target sites of sgRNA recognition within non-coding intergenic loci throughout the genomes of the cell lines screened. Applicants observe that sgRNAs that have predicted perfect match off-target cutting within amplified non-coding regions of the genome show strong dependency, whereas other sgRNAs directed at the same target genes do not show such profound dependency (FIG. 3F-3G). These data argue strongly that the number of CRISPR-Cas9 induced double-strand breaks, and the subsequent cellular reaction to this site-specific DNA-damage profoundly impacts cancer cell proliferation and viability.

Applicants next sought to better understand the copy number-dependency correlation across a variety of cancer cell lines that were screened by CRISPR-Cas9 technology. Applicants combined segmented copy number profiles from single nucleotide polymorphism array data with CRISPR-Cas9 dependency data for 32 cell line samples having both data types (12). In each cell line, Applicants identified genomic segments with defined copy number and labeled those segments by their mean CRISPR-Cas9 sensitivity values to enable correlation of CRISPR-Cas9 sensitivity with discrete segments of genomic copy number within and across various cell lines. Through combined analysis of all copy number segments with their associated mean CRISPR-Cas9 sensitivity values across all 32 samples, Applicants see a strong inverse correlation between copy number and sensitivity to CRISPR-Cas9 editing (FIG. 4A). Moreover, across all cell lines, Applicants do not see a strong correlation of mean CRISPR sensitivity with shRNA sensitivity within these amplified segments, looking at either the mean sensitivity or the most dependent probe on a copy number segment (FIG. 4B). Using the aforementioned analysis of mean sensitivity for a given copy number segment, Applicants more closely evaluated this relationship within individual cell lines. A strong correlation of CRISPR-Cas9 sensitivity and copy number exists within the majority of cell lines (FIG. 4C and Table 1). The magnitude of the slope of the regression line for a scatter plot of copy number and CRISPR-Cas9 sensitivity (CN-sensitivity slope) indicates the strength of this correlation and may serve as a metric for comparison across cell lines.

Given the importance of Cas9 activity for sgRNA double-strand break activity at target sites, Applicants next investigated the correlation of the positive-to-negative control sgRNA ratio (a surrogate for Cas9 activity) with the CN-dependency slope for each cell line. Applicants observed a strong correlation between the strength of the copy number versus CRISPR sensitivity relationship and the activity of Cas9 in the same cells, as gauged by the difference in depletion distributions between groups of sgRNAs that were selected as positive or negative controls for proliferation effects, suggesting that Cas9 activity and thus the efficacy of CRISPR-Cas9 genome modification is related to this phenomenon within copy number amplified segments (FIG. 4D).

To further investigate the significance of the copy number impact on CRISPR-Cas9 dependency, Applicants performed an analysis of strong dependencies in the dataset and characterized what fraction of those apparently strong gene dependencies were in genes found in regions of genomic amplification (FIG. 4E). Across our dataset of 32 cell lines with CRISPR-Cas9 screening data and copy number data, Applicants aggregated ATARiS gene scores into a single distribution and calculated a global z-score for dependency values, with each integer value representing one standard deviation from the mean of the distribution. Applicants observed that the fraction of dependencies in genes within a high-level amplification (defined as Log 2CN>1) increased with successive bins of increasing CRISPR-Cas9 dependency. Looking at only the maximal dependencies in these data, i.e. those with z-scores less than or equal to −6, Applicants observe that 32% of those dependencies reside within high-level amplifications. A similar phenomenon is not observed with shRNA data on the same cell lines (FIG. 4E). These data suggest that genomic amplification is a key determinant of may of the apparently strong dependency in CRISPR-Cas9 screening data but not shRNA screening data, implicating important mechanistic properties of CRISPR-Cas9 technology as responsible for this phenotype.

Applicants have performed CRISPR-Cas9 screening across a panel of 43 cancer cell lines and observe a striking correlation between copy number amplification and sensitivity to CRISPR-Cas9 modifications within the region of amplification. The magnitude of sensitivity increases with the amplitude of copy number amplification, with high-level copy number amplifications being responsible for the most profound apparent dependencies being observed within a particular cancer cell line (FIG. 5). Conversely, Applicants see enrichment of sgRNAs within regions of genomic deletion, further suggesting that the number of DNA cuts introduced by CRISPR-Cas9 is indeed responsible for this phenomenon. Through analysis of CRISPR-Cas9 targeting of both coding and non-coding non-genic regions within amplifications, it appears that this effect is independent of gene expression and thus likely related to the actual CRISPR-Cas9 DNA modification itself as well as the cellular response to this modification.

The mechanism of this strong correlation with CRISPR-Cas9 dependency and copy number amplification remains uncertain but likely relates to induction of multiple double-strand DNA breaks. However, Applicants have formulated two major mechanistic hypotheses that will require additional investigation with laboratory experiments. The first, and perhaps most likely, explanation posits that CRISPR-Cas9 targeting of amplified DNA regions leads to an intolerable level of DNA damage burden in cancer cells (with likely impaired DNA damage repair), thus resulting in mitotic catastrophe with resultant cell cycle arrest or cell death (FIG. 6A). Applicants would anticipate that diploid normal cells with intact DNA damage repair would sustain lower DNA damage burden from such sequence-directed CRISPR-Cas9-induced DNA damage and thus not show significant sensitivity (FIG. 6B). This model proposes that it is the amplified DNA that is the true target of this approach and does not necessitate that there is a major expressed driver oncogene within the amplified region.

The second hypothesis proposes that an essential driver oncogene may be structurally amplified through tandem repeats within the same chromosome (FIG. 7A). CRISPR-Cas9 induces double-stranded breaks that are then repaired by non-homologous end joining (NHEJ) by cancer and normal cells. In cancer cells, the net result is recombination of proximal and distal chromosome fragments, leading to loss of copies of the essential driver gene, thereby leading to cell cycle arrest or cell death. In normal cells, NHEJ repairs DNA in an error prone manner that is well tolerated by these cells, especially when a non-essential gene is targeted (FIG. 7B). Our initial investigation of amplicon structure and copy number using whole genome sequencing data suggests that the copy number-dependency correlation is not restricted to a single class of structural aberrations and may be a broader phenomenon better explained by cumulative DNA damage, as suggested above.

Wang et al. recently reported an analysis of cell essential genes in the human genome using CRISPR-Cas9 screening (13). They found that targeting several genes within the BCR-ABL amplification in the K562 leukemia cell line and JAK2 amplification in the HEL erythroleukemia cell line with CRISPR-Cas9 induced decreased cell viability associated with increased levels of phosphorylated histone H2AX, a marker of DNA damage. Here Applicants describe a global analysis of CRISPR-Cas9 sensitivity and copy number correlation in many epithelial cancer cell lines, which demonstrate that in epithelial cancers, the correlation between increased copy number and sensitivity to CRISPR-Cas9 targeting scores as the most robust gene-dependency relationship. Moreover, Applicants propose that this observation extends beyond an artifact of CRISPR-Cas9 technology and uncovers the important underlying concept that cancer cells are vulnerable to induction of site-specific double-stranded DNA breaks within regions of amplification. Most notably, this concept may have profound therapeutic implications that are not discussed in the recent report by Wang et al.

Importantly, both of our proposed mechanistic models suggest that targeting non-essential genes or even non-coding, intergenic regions of amplified DNA with CRISPR-Cas9 technology may unveil profound vulnerabilities in cancer cells. Our analysis of perfect match predicted off-target CRISPR-Cas9-induced modifications supports this hypothesis (FIG. 3F-G). Indeed, targeting non-coding regions of amplification would dramatically expand the number of targetable loci while also opening the possibility of novel therapies with an improved therapeutic window and efficacy (FIG. 7). One could envision simultaneous combination of CRISPR-Cas9 reagents to target multiple amplified loci within a given cancer cell, thus potentially maximizing the tumor-specific impact of this approach. This approach would utilize combination reagents to effect site-specific DNA damage in specific regions of the cancer genome that may have specificity over the genome of normal cells. While targeted therapies, such as kinase inhibitors, may be susceptible to evolution of resistance through a variety of mechanisms (increased expression, point mutations) that circumvent the targeted mechanism of action, sequence-specific DNA damaging agents may be less susceptible to such mechanisms of resistance.

It is highly likely that the number of CRISPR-Cas9-induced DNA breaks is the most pertinent factor in induction of an anti-proliferative or cytotoxic effect observed in our data. This conclusion is also supported by the recent mechanistic findings of Wang and colleagues showing induction of DNA damage in response to CRISPR-Cas9 genome modification within amplified loci (13). As such, the therapeutic value of this observation may extend beyond amplified regions. For instance, tumors may develop hundreds to thousands of mutations throughout the genome because of carcinogenic exposures and/or error-prone DNA repair mechanisms. These mutations are specific for the tumor and not observed within the normal cell. Multi-plexed delivery of CRISPR-Cas9 reagents to tumors targeting multiple tumor-specific mutated sequences may in effect generate multiple double-stranded DNA breaks, thus harnessing the strong site-specific anti-proliferative or cytotoxic effects observed here with CRISPR-Cas9 modifications.

While our data is derived from CRISPR-Cas9 screening, Applicants foresee that the observation is more broadly applicable and that other sequence-specific DNA-damaging agents may yield similar amplification-dependency profiles. The underlying concept that cancer cells with genomic amplification (or acquired tumor-specific sequence variation such as single nucleotide variants or insertions/deletions) are profoundly sensitive to introduction of site-specific double-strand breaks could form the foundation for an entirely new class of therapeutic agents that Applicants would term “site-specific DNA damaging agents.” Additional examples of such agents might include additional genome editing technologies such as Transcription activator-like effector nucleases (TALENs), Zinc-finger nucleases (ZFNs) or other nuclease proteins capable of site-directed DNA cleavage. Moreover, small molecule approaches that achieve preferential targeting in a site-specific manner within regions of amplified DNA may also confer a similar effect. For instance, oligonucleotide-directed chemotherapeutic or radioactive isotopes could be delivered in a sequence specific manner for targeting of amplified regions of cancer genomes. Moreover, utilization of the site-specific recognition of CRISPR-Cas9 to deliver nuclease-dead versions of Cas9 conjugated with DNA-damaging agents directly to amplified regions would be an additional valid approach. These novel agents could be used in combination with other treatment modalities such as cytotoxic DNA-damaging chemotherapies (e.g. cisplatin, etoposide), ionizing radiation, DNA-damage repair inhibitors (e.g. PARP-inhibitors) and apoptotic modulators (e.g. ABT-263) to enhance their cancer-specific impact. It is anticipated that the site-specific nature of the proposed novel class of therapies would enable dose reduction of conventional agents, such as cytotoxic chemotherapy or radiation therapy, and thus mitigation of possible side effects to the patient.

Applicants would specifically envision that genomic and functional genetic data derived from patient-specific biopsy material would enable identification of amplicon biomarkers that would guide development of sequence-specific DNA-damaging agents to target copy number-driven cancer types. Such therapies could be developed to commonly occurring regions of amplification, such as 8q24 harboring MYC, and patients would be enrolled onto trials based on the presence of such amplifications (or other cancer-specific sequence variations) within their tumor genome. Importantly, underlying DNA repair defects (e.g. BRCA1/2 or ATM) may also have predictive value for response to such site-specific DNA damaging agents and thus could further facilitate patient stratification. Through this approach, Applicants envision a precision medicine strategy to the development of patient-specific therapies based on individual cancer genome and functional dependency analyses.

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Having thus described in detail preferred embodiments of the present invention, it is to be understood that the invention defined by the above paragraphs is not to be limited to particular details set forth in the above description as many apparent variations thereof are possible without departing from the spirit or scope of the present invention.

Claims

1. A method for preparing a <span class="c3 g0">sequencespan>-specific DNA <span class="c15 g0">damagingspan> <span class="c16 g0">agentspan> suitable for the treatment of an <span class="c5 g0">epithelialspan> <span class="c6 g0">cellspan> <span class="c7 g0">cancerspan> of a <span class="c20 g0">humanspan> <span class="c21 g0">subjectspan>, said method comprising identifying a <span class="c7 g0">cancerspan> <span class="c6 g0">cellspan>-specific copy <span class="c10 g0">numberspan> <span class="c11 g0">amplificationspan> of said <span class="c5 g0">epithelialspan> <span class="c6 g0">cellspan> <span class="c7 g0">cancerspan> in genomic DNA of the <span class="c20 g0">humanspan> <span class="c21 g0">subjectspan>, wherein the <span class="c7 g0">cancerspan> <span class="c6 g0">cellspan>-specific copy <span class="c10 g0">numberspan> <span class="c11 g0">amplificationspan> comprises a non-coding, non-gene regulatory, intergenic region, and producing a <span class="c3 g0">sequencespan>-specific DNA <span class="c15 g0">damagingspan> <span class="c16 g0">agentspan>, wherein said <span class="c3 g0">sequencespan>-specific DNA <span class="c15 g0">damagingspan> <span class="c16 g0">agentspan> is a <span class="c4 g0">crisprspan>-Cas system nuclease comprising a <span class="c0 g0">guidespan> <span class="c1 g0">nucleicspan> <span class="c2 g0">acidspan> <span class="c3 g0">sequencespan> that is a <span class="c25 g0">perfectspan> <span class="c26 g0">matchspan> with a <span class="c1 g0">nucleicspan> <span class="c2 g0">acidspan> <span class="c3 g0">sequencespan> of the non-coding, non-gene regulatory, intergenic region across a span of at least twenty nucleotides in length within said <span class="c7 g0">cancerspan> <span class="c6 g0">cellspan>-specific genomic DNA copy <span class="c10 g0">numberspan> <span class="c11 g0">amplificationspan> of the <span class="c20 g0">humanspan> <span class="c21 g0">subjectspan> and thereby targets the non-coding, non-gene regulatory, intergenic region within said <span class="c7 g0">cancerspan> <span class="c6 g0">cellspan>-specific genomic DNA copy <span class="c10 g0">numberspan> <span class="c11 g0">amplificationspan> of the <span class="c20 g0">humanspan> <span class="c21 g0">subjectspan> for <span class="c8 g0">damagespan>, wherein the <span class="c0 g0">guidespan> <span class="c1 g0">nucleicspan> <span class="c2 g0">acidspan> <span class="c3 g0">sequencespan> is not a <span class="c25 g0">perfectspan> <span class="c26 g0">matchspan> with any gene or gene expression regulatory <span class="c3 g0">sequencespan> in the genome of the <span class="c20 g0">humanspan> <span class="c21 g0">subjectspan>.

2. The method according to claim 1, which comprises identifying said <span class="c7 g0">cancerspan> <span class="c6 g0">cellspan>-specific copy <span class="c10 g0">numberspan> <span class="c11 g0">amplificationspan> by sequencing a sample of said <span class="c5 g0">epithelialspan> <span class="c6 g0">cellspan> <span class="c7 g0">cancerspan>.

3. The method according to claim 1, wherein said <span class="c3 g0">sequencespan>-specific DNA <span class="c15 g0">damagingspan> <span class="c16 g0">agentspan> is a patient-specific DNA <span class="c15 g0">damagingspan> <span class="c16 g0">agentspan>, and said <span class="c7 g0">cancerspan> <span class="c6 g0">cellspan>-specific copy <span class="c10 g0">numberspan> <span class="c11 g0">amplificationspan> is identified based on sequencing a sample of said patient.

4. The method according to claim 1, wherein said <span class="c7 g0">cancerspan> <span class="c6 g0">cellspan>-specific copy <span class="c10 g0">numberspan> <span class="c11 g0">amplificationspan> is not present in a normal <span class="c6 g0">cellspan> or a non-cancerous <span class="c6 g0">cellspan>.

5. The method according to claim 1 wherein the copy <span class="c10 g0">numberspan> <span class="c11 g0">amplificationspan> comprises DNA copy <span class="c10 g0">numberspan> amplifications of 1p22-p31, 1p32-p36, 1q, 2p13-p16, 2p23-p25, 2q31-q33, 3q, 5p, 6p12-pter, ′7p12-p13, 7q11.2, 7q21-q22, 8p11-p12, 8q, 11q13-q14, 12p, 12q13-q21, 13q14, 13q22-qter, 14q13-q21, 15q24-qter, 17p11.2-p12, 17q12-q21, 17q22-qter, 18q, 19p13.2-pter, 19cen-q13.3, 20p11.2-p12, 20q, Xp11.2-p21, or Xp11-q13.

6. The method according to claim 1, wherein the <span class="c4 g0">crisprspan>-Cas system nuclease is a nickase.

7. The method according to claim 1, wherein the <span class="c4 g0">crisprspan>-Cas system nuclease comprises one or more mutations.

8. The method according to claim 7, wherein the <span class="c4 g0">crisprspan>-Cas system nuclease comprises one or more mutations selected from D10A, E762A, H840A, N854A, N863A or D986A with reference to the position numbering of a Streptococcus pyogenes Cas9 (SpCas9) nuclease.

9. The method according to claim 7, wherein the one or more mutations is in a RuvC1 domain of the <span class="c4 g0">crisprspan>-Cas system nuclease.

10. The method according to claim 1, wherein the <span class="c4 g0">crisprspan>-Cas system nuclease cleaves the target <span class="c3 g0">sequencespan>.

11. The method according to claim 1, wherein the <span class="c4 g0">crisprspan>-Cas system nuclease is a dead Cas conjugated to a DNA <span class="c15 g0">damagingspan> <span class="c16 g0">agentspan>.

12. The method according to claim 1, wherein the <span class="c5 g0">epithelialspan> <span class="c6 g0">cellspan> <span class="c7 g0">cancerspan> is selected from the group consisting of Non-Hodgkin's Lymphoma (NHL), clear <span class="c6 g0">cellspan> Renal <span class="c6 g0">cellspan> Carcinoma (ccRCC), melanoma, sarcoma, leukemia, a <span class="c7 g0">cancerspan> of the bladder, colon, rectum, brain, breast, head and neck, endometrium, lung, uterus, ovary, peritoneum, fallopian tubes, pancreas, esophagus, stomach, small intestine, liver, gall bladder, bile ducts and prostate <span class="c7 g0">cancerspan>.